From the Guidelines
A preoperative history and physical (H&P) should include a comprehensive medical assessment, including the patient's chief complaint, history of present illness, past medical and surgical history, medications, allergies, family history, social history, and review of systems, as well as a thorough physical examination to assess vital signs and examine all major organ systems, with particular attention to areas relevant to the planned procedure 1. The H&P should also seek to identify serious cardiac conditions such as unstable coronary syndromes, prior angina, recent or past MI, decompensated heart failure, significant arrhythmias, and severe valvular disease, as well as determine the patient's functional capacity and assess their risk factors for perioperative cardiovascular risk 1. The assessment should include the patient's ASA (American Society of Anesthesiologists) physical status classification, and the plan should outline the proposed procedure, anesthesia type, and any special considerations, with the goal of promoting patient engagement and facilitating shared decision making by providing patients and their providers with clear, understandable information about perioperative cardiovascular risk in the context of the overall risk of surgery 1. Some key points to consider in the preoperative H&P include:
- Accurate recording of current medications used, including herbal and other nutritional supplements, and dosages is essential 1
- Use of alcohol, tobacco, and over-the-counter and illicit drugs should be documented 1
- The patient's functional capacity should be assessed, including their ability to perform common daily tasks 1
- The preoperative consultation may represent the first careful cardiovascular evaluation for the patient in years or, in some instances, ever, and should be used to identify risk factors for complications and establish baseline health status 1 A well-documented preoperative H&P also serves as a legal record and facilitates communication among the healthcare team members involved in the patient's care, and should be used to guide anesthetic management and ensure the patient is optimally prepared for surgery 1.
From the Research
Preoperative History and Physical (H&P)
The preoperative history and physical (H&P) is a crucial component of preoperative evaluation, aiming to assess the patient's health and identify potential risks associated with surgery.
- The H&P should include a thorough review of the patient's medical, behavioral, and social history, as well as previous complications with surgery or anesthesia 2.
- The physical examination should involve the identification of airway anomalies, evaluation of cardiac, respiratory, neurologic, and fluid status, and assessment of the patient's overall physical condition 2.
- The American Society of Anesthesiologists Physical Status (ASA-PS) is a commonly used tool to classify the patient's risk category 3.
- Frailty, cognitive, and functional tools are also frequently utilized to assess the patient's physical and cognitive status 3.
Components of Preoperative H&P
The preoperative H&P should include:
- Medical history: review of the patient's medical conditions, allergies, and medications 4, 2.
- Behavioral and social history: assessment of the patient's behavioral and social factors that may impact surgery 2.
- Physical examination: evaluation of the patient's airway, cardiac, respiratory, neurologic, and fluid status 2.
- Laboratory testing: targeted laboratory and imaging studies may be necessary for patients with underlying conditions 2.
- Risk assessment: classification of the patient's risk category using tools such as the ASA-PS 3.
Importance of Preoperative H&P
A thorough preoperative H&P is essential to: