From the Guidelines
The primary requirement for preoperative clearance is not to give medical clearance, but rather to perform an evaluation of the patient's current medical status and provide a clinical risk profile to guide treatment decisions 1.
Key Components of Preoperative Evaluation
- Evaluation of the patient's current medical status
- Assessment of cardiac risk
- Recommendations for evaluation, management, and risk of cardiac problems over the entire perioperative period
- Provision of a clinical risk profile to inform treatment decisions
Decision Making
The goal of preoperative evaluation is to provide a framework for considering cardiac risk of noncardiac surgery, and no test should be performed unless it is likely to influence patient treatment 1.
Clinical Considerations
The overriding theme of preoperative evaluation is that intervention is rarely necessary to simply lower the risk of surgery unless such intervention is indicated irrespective of the preoperative context 1.
Best Practices
Preoperative evaluation should be focused on providing optimal care for the patient, rather than simply giving medical clearance. This involves considering the patient's individual risk factors and developing a personalized plan for perioperative care.
From the Research
Preoperative Clearance Requirements
The requirements for preoperative (pre-op) clearance involve a thorough evaluation of the patient's medical conditions and comorbidities to ensure safe surgery. Key aspects of preoperative clearance include:
- Assessment of patient medical conditions that require additional time for preoperative clearance by anesthesiology before scheduling the date of surgery 2
- Evaluation of comorbidities, such as cardiac conditions, to determine the need for further investigation before elective operations 3
- Screening for potential cervical spine disease, particularly in older surgical candidates, to prevent iatrogenic cervical spine injury during surgery 4
- Comprehensive history and physicals, although their necessity has been debated, with some studies suggesting they may lead to unnecessary preoperative testing 5
Patient Evaluation and Testing
Patient evaluation and testing are crucial components of preoperative clearance, including:
- Preoperative history and physicals (H&Ps) to assess patient comorbidities and identify potential risks 5
- Preoperative testing, such as laboratory tests and imaging studies, to evaluate patient health and detect potential issues 5
- Cervical spine clearance protocols, including sustained neck extension maneuvers, to identify patients susceptible to iatrogenic cervical spine injury 4
Preoperative Care and Management
Preoperative care and management involve a multidisciplinary approach, including:
- Nurse-led preoperative outpatient appointments to provide patient education and conduct clinical assessments 6
- Anesthesiologist-led preoperative evaluation and management services to optimize patient health before surgery 2
- Collaboration between healthcare professionals to ensure comprehensive preoperative care and minimize risks 3