What are the requirements for surgical clearance?

From the Guidelines

Surgery clearance should not be viewed as a process of simply "clearing" a patient for surgery, but rather as a comprehensive evaluation of the patient's current medical status to identify potential risks and optimize their care. To obtain surgery clearance, patients should schedule an appointment with their primary care physician or a specialist, such as a cardiologist, typically 2-4 weeks before their scheduled procedure 1. During this appointment, the doctor will review the patient's medical history, current medications, allergies, and perform a physical examination. They may order tests such as blood work, EKG, chest X-ray, or other specialized tests depending on the patient's health conditions and the type of surgery planned.

The purpose of preoperative evaluation is not to give medical clearance, but rather to perform an evaluation of the patient's current medical status, make recommendations concerning the evaluation, management, and risk of cardiac problems over the entire perioperative period, and provide a clinical risk profile that the patient, primary physician, and nonphysician caregivers, anesthesiologist, and surgeon can use in making treatment decisions that may influence short- and long-term cardiac outcomes 1. The consultant should not use phrases such as "clear for surgery," but rather provide a comprehensive assessment that addresses all relevant aspects of the patient's cardiovascular health 1.

Some key points to consider during the surgery clearance process include:

• Disclosing all medications, including over-the-counter drugs, supplements, and herbal remedies, as some may need to be temporarily stopped before surgery
• Identifying potential risks that could lead to complications during or after surgery
• Optimizing chronic conditions to reduce the risk of perioperative cardiac problems
• Determining the safest anesthetic approach for the procedure
• Providing a comprehensive assessment of the patient's cardiovascular health to inform treatment decisions.

Ultimately, the goal of the consultation is the optimal care of the patient, and the consultant should prioritize providing a comprehensive evaluation and recommendations that address the patient's individual needs and risks.

From the Research

Surgery Clearance

• A thorough preoperative evaluation is mandatory for all patients undergoing any surgical procedure to identify correctable medical abnormalities and understand the residual risk 2
• The evaluation process varies among patients, depending on age and general health, and includes assessing the medical condition of patients, evaluating their overall health status, determining risk factors, and educating them 2, 3
• Nurses play an important role in the preassessment of surgical patients, ensuring quality patient care from the moment patients enter the office to when they are discharged from care 3
• A comprehensive patient assessment represents the first step for an anaesthetist to evaluate the risks associated with the procedure and the patient's underlying diseases, and to optimise the perioperative surgical journey 4
• The European Society of Anaesthesiology and Intensive Care provides updated guidelines for the preoperative assessment of adults undergoing elective noncardiac surgery, including 55 evidence-based recommendations 4

Patient Evaluation

• Patients with diabetes mellitus and hypertension are at high risk of future vascular events and require careful evaluation and management 5, 6
• The combination of aspirin plus rivaroxaban 2.5 mg twice daily provides a similar relative degree of benefit on coronary, cerebrovascular, and peripheral end points in patients with and without diabetes mellitus 6
• A tailored assessment of each patient's fitness to undergo procedures requiring the involvement of an anaesthetist is essential, taking into account their clinical conditions and risk factors 4

Preoperative Assessment

• The preoperative assessment should include a comprehensive literature review, evaluation of the methodological quality of the studies, and a Delphi process to agree on the wording of recommendations 4
• Telemedicine and predictive preoperative scores and biomarkers can guide the anaesthetist in selecting the appropriate preoperative blood tests, x-rays, and other evaluations for each patient 4
• The anaesthetist's role is essential in the preoperative assessment phase to obtain a broad vision of the patient's clinical conditions, coordinate care, and help the patient reach an informed decision 4