Who provides medical clearance for surgery?

From the Guidelines

Medical clearance for surgery is typically provided by a primary care physician, internal medicine specialist, or cardiologist, depending on the patient's health status and the complexity of the surgery. The physician evaluates the patient's overall health, reviews medical history, performs a physical examination, and orders necessary tests such as blood work, electrocardiograms, or chest X-rays. For patients with specific health conditions, specialists like cardiologists for heart issues or pulmonologists for lung problems may be consulted. The clearance process aims to identify and address potential risks before surgery, optimize the patient's health status, and ensure they can safely undergo anesthesia and the surgical procedure. The anesthesiologist also plays a crucial role in this process, reviewing the clearance information and making the final determination about anesthesia safety. This comprehensive evaluation helps reduce surgical complications and improves outcomes by ensuring patients are in the best possible condition before their procedure, as recommended by the American College of Cardiology and American Heart Association guidelines 1.

Key Considerations

• The consultant should review available patient data, obtain a history, and perform a physical examination that includes a comprehensive cardiovascular examination and elements pertinent to the patient’s problem and the proposed surgery 1.
• The consultant may recommend changes in medication, suggest preoperative tests or procedures, or propose higher levels of care postoperatively 1.
• Preoperative tests are recommended only if the information obtained will result in a change in the surgical procedure performed, a change in medical therapy or monitoring during or after surgery, or a postponement of surgery until the cardiac condition can be corrected or stabilized 1.
• The consultant should not use phrases such as “clear for surgery” and instead provide a comprehensive assessment that addresses all relevant aspects of the patient’s cardiovascular health 1.

Importance of Communication

• The consultant must ensure clarity of communication so that findings and impressions will be incorporated effectively into the patient’s overall plan of care 1.
• Direct communication with the surgeon, anesthesiologist, and other physicians, as well as frank discussion directly with the patient and, if appropriate, the family, is essential 1.

From the Research

Medical Clearance for Surgery

The process of obtaining medical clearance for surgery typically involves a thorough evaluation of the patient's overall health and medical history.

• The primary goal of medical clearance is to assess the patient's risk for surgery and anesthesia, and to identify any potential health issues that may need to be addressed before the procedure.
• This evaluation is usually performed by the patient's primary care physician or a specialist, such as a cardiologist or anesthesiologist, depending on the patient's medical history and the type of surgery being performed 2.
• The medical clearance process may involve a review of the patient's medical history, a physical examination, and diagnostic tests such as blood work or imaging studies.
• In some cases, patients may be required to stop taking certain medications, such as anticoagulants, before surgery, and may need to undergo additional testing or evaluation to ensure that it is safe for them to undergo the procedure 3, 4.

Role of Anesthesiologists and Surgeons

Anesthesiologists and surgeons play a critical role in the medical clearance process, as they are responsible for evaluating the patient's risk for anesthesia and surgery.

• Anesthesiologists are responsible for assessing the patient's airway, breathing, and circulation, and for developing an anesthesia plan that takes into account the patient's medical history and any potential health issues 2.
• Surgeons are responsible for evaluating the patient's overall health and medical history, and for determining whether the patient is a good candidate for surgery.
• Both anesthesiologists and surgeons work together to ensure that the patient is properly prepared for surgery, and that any potential health issues are addressed before the procedure.

Perioperative Management

The perioperative period, which includes the time before, during, and after surgery, is a critical time for patients undergoing surgical procedures.

• During this time, patients are at risk for a range of complications, including bleeding, infection, and respiratory problems.
• Anesthesiologists and surgeons work together to manage the patient's care during the perioperative period, and to minimize the risk of complications 3, 4.
• This may involve the use of medications, such as anticoagulants, to prevent bleeding or thrombosis, as well as close monitoring of the patient's vital signs and laboratory results.