What Is a Preoperative Evaluation?

A preoperative evaluation is an assessment of risk factors that need to be considered in a patient's surgical planning. It may indicate a patient is not stable enough for surgery and needs to wait, or that adjustments may need to be made to the anesthesia or surgery plans to protect the patient’s health and safety. This can include a physical examination and blood testing along with conversations with the surgeon, anesthesiologist, and any specialists the patient may be seeing. Information from the evaluation is entered in the patient’s chart to create a permanent record.

One aspect of a preoperative evaluation is the diagnosis and development of plans for surgery, whether it is medically necessary or elective. The patient can discuss the options and any preferences and the surgeon can conduct a physical examination to check on heart and lung function and assess the patient’s general level of health. A patient history is also collected to check for risk factors like previous adverse reactions to anesthesia, underlying medical problem, or a family history of issues with anesthetics.

If the examination and history turn up issues, the preoperative evaluation moves on to determining the level of risk involved. Patients with diabetes or high blood pressure, for example, may need to be specially handled in the operating room. The surgeon can meet with the anesthesiologist and the patient’s primary care provider to discuss safety concerns and determine if the surgery can move forward. In the surgical planning, the surgeon can establish guidelines to protect the patient during the procedure and in recovery.

Underlying conditions need to be well-controlled prior to surgery, if possible. During the preoperative evaluation, the surgeon may direct the patient to stop taking certain medications to start taking new ones just before surgery to address risks. For example, people taking anticoagulants present a risk in surgery and might need to stop therapy before surgery. Patients should make sure their doctors know about any over the counter drugs, including herbal preparations, as these can also have an impact in the operating room.

The goal is to clear the patient for surgery, making sure the case meets criteria set by the hospital or institution for safety. In some special cases, a patient may clearly need surgery despite serious risks that would normally preclude it. Surgeons may need to obtain special consent or meet with an ethics committee to discuss the preoperative evaluation and get approval before they can authorize a surgery.