From the Guidelines
A pre-operative clearance form should include a comprehensive medical history review, physical examination, vital signs assessment, and laboratory tests such as complete blood count (CBC), comprehensive metabolic panel, coagulation studies (PT/INR, PTT), urinalysis, and electrocardiogram (ECG) to assess a patient's fitness for surgery. The specific exams required vary based on the patient's age, medical history, and the type of surgery planned, as outlined in the guidelines by the American College of Cardiology and American Heart Association 1.
Key Components of Pre-Operative Clearance
- Comprehensive medical history review to identify potentially serious cardiac disorders, including coronary artery disease (CAD), heart failure (HF), and symptomatic arrhythmias 1
- Physical examination to assess functional capacity and identify any signs of cardiac or other systemic disease
- Vital signs assessment to evaluate the patient's current hemodynamic status
- Laboratory tests, including:
- Complete blood count (CBC) to assess for anemia or other hematologic abnormalities
- Comprehensive metabolic panel to evaluate renal function, electrolyte balance, and glucose control
- Coagulation studies (PT/INR, PTT) to assess bleeding risk
- Urinalysis to evaluate for urinary tract infection or other renal issues
- Electrocardiogram (ECG) to assess for cardiac arrhythmias or ischemia
Additional Tests Based on Patient Profile
Additional tests may be necessary based on the patient's profile, including:
- Chest X-ray to evaluate lung expansion and cardiac silhouette
- Pulmonary function tests to assess lung function in patients with respiratory disease
- Specialized cardiac evaluations like echocardiogram or stress tests for patients with cardiac risk factors, as recommended by the ACC/AHA guidelines 1
Goal of Pre-Operative Clearance
The goal of pre-operative clearance is to minimize surgical risks by identifying and addressing health concerns beforehand, ensuring the safest possible surgical experience for the patient, as emphasized in the guidelines 1. This approach prioritizes morbidity, mortality, and quality of life outcomes by optimizing patient care before surgery.
From the Research
Pre-Op Clearance Form Exams
The exams that constitute a pre-op clearance form are not explicitly stated in the provided studies. However, based on the information available, the following points can be considered:
- A thorough history taking and physical examination of all patients before surgery seems important until more evidence-based guidelines become available 2
- The benefits of routine testing for all surgical patients before operation are extremely limited and are not advocated 2
- Diagnostic and prognostic prediction studies may provide the necessary evidence to determine the required exams for pre-op clearance 2
Relevant Exams
Some exams that may be relevant to pre-op clearance include:
- Cardiac auscultation to diagnose valvular heart disease 2
- Tests to predict the difficulty of endotracheal intubation 2
- Coronary angiography to evaluate coronary atherosclerosis in patients with diabetes 3, 4
- Myocardial blush grade (MBG) and myocardial filling time (MFT) to evaluate microvascular circulation in patients with diabetes 4
- Vitamin D levels assessment to evaluate its relationship with the extent of coronary artery disease 5
Patient-Specific Exams
The exams required for pre-op clearance may vary depending on the patient's specific condition, such as: