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Preoperative Testing & Evaluation: What to Expect Before Surgery

Preoperative assessment (preadmission testing) ensures you are optimized for anesthesia and surgery, identifies modifiable risks, and prevents day-of-surgery cancellations. Here’s what typically happens:

1. Health History Review

Past/present illnesses, surgeries, hospitalizations.
Current medications (including OTC, supplements, herbals) – bring a list.
Allergies (medications, latex, tape, contrast, food) + reaction type.
Anesthesia history (personal/family): malignant hyperthermia, pseudocholinesterase deficiency, difficult airway, nausea.
Social history: tobacco, alcohol, substance use (affects healing, withdrawal risk).
Functional status: exercise tolerance (METs), ADL independence, fall risk.

2. Focused Physical Examination

Airway assessment (Mallampati, thyromental distance, neck mobility, dentition).
Cardiopulmonary: heart/lung exam, baseline vitals, O2 saturation.
Surgical site inspection (skin integrity, infection, markers).
Neurologic baseline (if relevant).

3. Diagnostic Testing (Risk-Stratified, Not Routine)

Choosing Wisely / ASA guidelines: Tests ordered based on age, comorbidities, surgery invasiveness—not age alone.

4. Specialized Consultations (As Needed)

Cardiology (stress test, echo, cath) – active cardiac conditions.
Pulmonology (PFTs, ABG) – severe COPD, restrictive disease.
Hematology – anticoagulation management, bleeding disorders.
Endocrinology – uncontrolled diabetes, thyroid storm risk.
Infectious Disease – active infection, complex device infections.

5. Optimization Interventions

Medication adjustments: Hold ACEi/ARB, diuretics, SGLT2i, anticoagulants, antiplatelets per protocol.
Anemia management: IV iron, EPO if time permits.
Glycemic control: Target HbA1c <8%, perioperative insulin protocol.
Smoking cessation: Even 4 weeks reduces complications.
Nutritional optimization: Immunonutrition (arginine, omega-3) for major cancer surgery.
Prehabilitation: Exercise, breathing training, carbohydrate loading.

6. Informed Consent & Education

Procedure, alternatives, risks, benefits, expected recovery.
Anesthesia consent (separate).
Pre-op instructions: NPO, medication timing, chlorhexidine shower, arrival time.

Preoperative evaluation is a collaborative safety checkpoint—not a hurdle. Engage actively: ask questions, disclose everything, follow the plan.

Bypass Surgery - Related Articles

Test	Typical Indications
CBC	Anemia risk, anticipated blood loss, chemotherapy, renal disease
Basic/Comprehensive Metabolic Panel	Renal/hepatic dysfunction, diuretics, major fluid shifts, electrolyte disorders
Coagulation (PT/INR, aPTT)	Anticoagulants, liver disease, known coagulopathy, major vascular/neuro surgery
HbA1c	Diabetes (optimize >8% if elective)
ECG	Age >65, cardiac history, hypertension, dyspnea, major surgery
Chest X-ray	Cardiopulmonary symptoms, known disease, thoracic/upper abdominal surgery
Pregnancy test (β-hCG)	All women of childbearing potential (urine or serum)
Type & Screen / Crossmatch	Procedures with >10% transfusion risk