What pre-operative clearance tests are needed?

From the Guidelines

Pre-operative clearance tests should be based on the history and physical examination findings, perioperative risk assessment, and clinical judgment, rather than routine testing for all patients. The decision to perform preoperative testing should be individualized, taking into account the patient's specific health conditions, medications, and the complexity of the planned procedure 1.

Key Considerations

• A comprehensive medical history and physical examination are essential components of pre-operative evaluation
• Additional tests, such as blood tests (complete blood count, metabolic panel, coagulation studies), electrocardiogram (ECG), and chest X-ray, may be required based on the patient's specific health conditions and the type of surgery planned
• Patients with cardiac issues may require an echocardiogram or stress test, while those with respiratory problems may need pulmonary function tests
• Diabetic patients should have blood glucose monitoring, and those on blood thinners require coagulation profile assessment

Recommendations

• The American College of Cardiology/American Heart Association recommends that preoperative resting 12-lead ECG is reasonable for patients with known coronary heart disease or other significant structural heart disease, except for low-risk surgery 1
• Routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures 1
• Preoperative evaluation of LV function is reasonable for patients with dyspnea of unknown origin or heart failure with worsening dyspnea or other change in clinical status 1
• Routine preoperative evaluation of LV function is not recommended for clinically stable patients 1

Important Considerations

• The specific tests ordered depend on the patient's age, existing medical conditions, medications, and the complexity of the planned procedure
• It is essential to disclose all medications, supplements, and medical conditions to the healthcare provider during pre-operative evaluation to ensure comprehensive assessment and minimize surgical complications
• Pre-operative testing should be guided by the patient's individual risk factors and the type of surgery planned, rather than a one-size-fits-all approach 1

From the FDA Drug Label

PT/INR determination is recommended just prior to any dental or surgical procedure. The patient should undergo a PT/INR test before any surgical procedure to ensure they are within the therapeutic range.

• This test is necessary to assess the patient's blood clotting and determine the risk of bleeding during surgery.
• The results of the PT/INR test will help guide the management of the patient's anticoagulation therapy during the surgical procedure 2.

From the Research

Pre-Operative Clearance Tests

The following tests are commonly required for pre-operative clearance:

• Complete Blood Count (CBC) 3, 4, 5, 6
• Carcinoembryonic antigen (CEA) 5
• Colonoscopy 5
• Chest radiograph 5

Rationale for CBC in Pre-Operative Clearance

CBC is a useful test in pre-operative clearance as it provides information on:

• White blood cell count, which can indicate infection or inflammation 3, 4
• Hemoglobin and hematocrit levels, which can indicate anemia or blood loss 3, 4
• Platelet count, which can indicate bleeding or clotting disorders 3, 4
• Red blood cell indices, which can indicate nutritional deficiencies or other underlying conditions 4

Specific Pre-Operative Clearance Tests for Colon Cancer Surgery

For colon cancer surgery, the following tests are recommended:

• Complete Blood Count (CBC) 5
• Carcinoembryonic antigen (CEA) 5
• Colonoscopy 5
• Chest radiograph 5
• Bowel preparation, parenteral antibiotics, and deep venous thrombosis prophylaxis are also recommended as part of the pre-operative evaluation 5