From the Guidelines
Preoperative care should prioritize a comprehensive approach to prepare patients for surgery and minimize complications, including patient assessment, medication management, infection prevention, and anesthesia evaluation, as recommended by recent guidelines 1. The process begins with a thorough patient assessment, including medical history review, physical examination, and evaluation of current medications to identify potential risk factors.
- Laboratory tests, such as complete blood count, coagulation studies, and metabolic panel, and diagnostic imaging are ordered based on the patient's condition and planned procedure.
- Medication management is crucial, with instructions to continue essential medications like antihypertensives while discontinuing anticoagulants and certain supplements, as well as managing diabetes care in the hospital setting 1.
- Patients are typically instructed to fast for 6-8 hours before surgery, with clear liquids allowed up to 2 hours pre-procedure, to prevent aspiration.
- Infection prevention measures include preoperative antibiotics and chlorhexidine skin preparation.
- Patient education about the procedure, expected outcomes, and postoperative care helps reduce anxiety and improve compliance.
- Venous thromboembolism prophylaxis with mechanical methods or pharmacological agents may be initiated.
- Finally, anesthesia evaluation determines the appropriate anesthetic approach and identifies potential airway or medication concerns. This comprehensive approach ensures patients are optimally prepared for surgery, reducing the risk of complications and improving outcomes, as supported by recent studies 1.
From the Research
Key Components of Preoperative Care
The key components of preoperative (PreOp) care include:
- Preoperative screening and risk assessment to identify patients at risk for major morbidity, death, or hospital admission 2
- Optimization of the patient's health status before surgery 2
- Identification of risk factors that may influence postoperative outcomes, such as age, hospital admission within the previous 6 months, and invasiveness of surgery 2
- Use of preoperative risk evaluation scores, such as the Preoperative Score to Predict Postoperative Mortality (POSPOM), the Universal ACS NSQIP surgical risk calculator (ACS-NSQUIP), the Clinical Frailty Scale (CFS), and the American Society of Anesthesiologists Physical Status (ASA-PS) classification system, to predict perioperative risks 3
- A multidisciplinary approach to preoperative assessment, involving the anesthesiologist and other healthcare professionals 2
Preoperative Evaluation
The preoperative evaluation should:
- Build patient-physician rapport and trust 4
- Identify potential problems and address them before surgery 4
- Confirm and establish diagnoses and treatment approaches 4
- Provide patient education 4
- Ensure better outcomes for both the surgeon and the patient 4
Preoperative Testing
Preoperative laboratory and electrocardiographic testing should be:
- Driven by the patient's history and physical examination and the risk of the surgical procedure 5
- Indicated only if it can correctly identify abnormalities and change the diagnosis, management plan, or patient outcome 5
- Standardized and optimized through preoperative evaluation centers to reduce unnecessary testing and delays 5
Special Considerations
In pediatric patients, a thorough preoperative evaluation is crucial to identify anesthetic risks, and a clear and comprehensive system should be in place to process patients during the preoperative period 6