From the Guidelines
A pre-operative assessment should be conducted to identify and mitigate risks before surgery, with the ultimate goal of reducing perioperative morbidity and mortality, and optimizing patient outcomes, as recommended by the most recent guidelines 1. The key components of a pre-operative assessment include:
- A comprehensive medical history review
- Physical examination
- Medication reconciliation
- Laboratory/diagnostic testing tailored to the patient's condition and planned procedure During the assessment, clinicians evaluate:
- Cardiovascular status
- Respiratory function
- Metabolic health
- Anesthesia risks
- Potential complications such as bleeding risks, infection susceptibility, or difficult airways Medication management is crucial, determining which medications should be continued, temporarily stopped, or adjusted before surgery, with particular attention to anticoagulants, antihypertensives, and diabetes medications, as highlighted in the guidelines 1. The assessment also includes:
- Patient education about the procedure, expected recovery, and post-operative care
- Addressing patient concerns and obtaining informed consent
- Functional capacity evaluation to predict post-operative recovery potential and guide rehabilitation planning
- Nutritional status assessment to identify malnourished patients who may need pre-operative nutritional support, as recommended by the ERAS society guidelines 1. The pre-operative assessment should be tailored to the individual patient's needs, taking into account their medical history, current health status, and the planned surgical procedure, as emphasized in the most recent consensus recommendations 1.
From the Research
Pre-Operative Assessment Components
- Medical history review: assessing the patient's medical history, including any pre-existing conditions, allergies, and previous surgeries 2
- Physical examination: evaluating the patient's physical condition, including vital signs, to identify any potential risks or concerns
- Laboratory tests: conducting laboratory tests, such as blood work and urinalysis, to assess the patient's overall health and identify any potential issues
- Medication review: reviewing the patient's current medications, including any potential interactions or contraindications with anesthesia or other medications
Pre-Operative Assessment Goals
- Evaluate the patient's overall health and identify any potential risks or concerns
- Develop a plan for anesthesia and pain management
- Optimize the patient's medical condition before surgery
- Reduce the risk of complications during and after surgery
- Ensure the patient is informed and prepared for the surgical procedure
Key Considerations
- Hypertension management: controlling blood pressure to reduce the risk of cardiovascular complications during surgery 3, 4, 5, 2, 6
- Medication management: managing the patient's medications to minimize potential interactions or contraindications with anesthesia or other medications
- Patient education: educating the patient on the surgical procedure, potential risks and complications, and post-operative care instructions