From the Guidelines
For a 25-year-old female with no medical history undergoing ankle surgery, no preoperative testing is typically needed beyond a focused history and physical examination. A basic preoperative assessment should include vital signs, airway evaluation, and a review of any medications or allergies. The decision to order preoperative tests should be guided by the patient’s clinical history, comorbidities, and physical examination findings, as recommended by the American Family Physician guidelines 1. According to the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery, routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures, such as ankle surgery 1.
Some key points to consider in the preoperative evaluation include:
- A complete blood count is indicated for patients with diseases that increase the risk of anemia or patients in whom significant perioperative blood loss is anticipated, but this is not typically a concern for a healthy 25-year-old female undergoing ankle surgery 1.
- Coagulation studies are reserved for patients with a history of bleeding or medical conditions that predispose them to bleeding, and for those taking anticoagulants, but again, this is not typically a concern for a healthy 25-year-old female 1.
- Electrolyte and creatinine testing should be performed in patients with underlying chronic disease and those taking medications that predispose them to electrolyte abnormalities or renal failure, but this is not relevant to a healthy 25-year-old female with no medical history 1.
In general, the goal of preoperative evaluation is to identify and optimize conditions that increase perioperative morbidity and mortality, and for a healthy 25-year-old female undergoing ankle surgery, a focused history and physical examination are sufficient to achieve this goal 1. The anesthesiologist might order specific tests based on their evaluation, but for a healthy young adult, extensive preoperative testing is rarely beneficial and does not improve surgical outcomes.
From the Research
Presurgical Testing for Ankle Surgery
For a 25-year-old female with no medical history undergoing ankle surgery, the necessity of presurgical testing is a consideration.
- The provided studies do not directly address presurgical testing for ankle surgery in young, healthy individuals 2, 3, 4, 5, 6.
- However, study 5 discusses preoperative evaluation for minimally invasive gynecologic surgery, suggesting that a thorough history and physical examination are the foundation of this assessment, and that unnecessary laboratory and diagnostic testing should be avoided.
- Studies 3, 4, and 6 provide information on the complete blood count (CBC) and its components, but do not specifically address presurgical testing for ankle surgery.
- There is no direct evidence in the provided studies to support the necessity of presurgical testing for a healthy 25-year-old female undergoing ankle surgery 2, 3, 4, 5, 6.
Laboratory Tests
- The basic metabolic panel and complete blood count are common laboratory tests, but their necessity for presurgical testing in this scenario is not supported by the provided evidence 2, 3, 4, 6.
- Study 5 suggests that using a protocol to guide preoperative testing can improve patient care by eliminating unnecessary tests.