Surgical Risk with a Preoperative Assessment

Most individuals who are planning to undergo a surgical procedure will undergo a preoperative assessment. The goal of this preop evaluation can be summed up in one question that the physician asks him or herself with every patient: What does this person need in order to undergo the operation with the lowest risk possible?

Several areas are considered in the pre-operative assessment. First, the indivdual’s risk will be assessed by taking a thorough history and doing a full physical exam. Areas of particular concern that your physician should address preoperatively include:

1. cardiac (heart)

2. pulmonary (lungs)

3. hepatic (liver)

4. renal (kidneys)

5. gastrointestinal

6. hematological (blood)

7. diabetes and other endocrine issues

Consideration of the baseline nutritional status is important as well. Risk is increased if an individual is less than 80% or more than 120% of their ideal body weight. The ideal body weight is 106 lbs + 6/inch over 5 ft for males, or 100 lb + 5/inch over 5 ft for females. Risk is also increased there has been a recent change of more than 10% of one’s body weight.

Any medical conditions that are identified by the doctor should be optimally treated before undergoing the operation. Among other aspects of medical management, this may mean starting, stopping, switching or changing the dose of certain medications.

As a general rule medications for high blood pressure are continued except for diuretics such as hydrochlorothiazide (HCTZ) and furosemide (Lasix). Aspirin should not be taken for 10 days prior to surgery. Insulin should be held on the day of surgery. NSAIDs, such as ibuprofen, and selective COX-2 inhibitors, such as Celebrex, may need to be held as well since they can exacerbate bleeding.

A major factor in preop surgery risk is the anesthesia assessment. Any prior complications associated with anesthesia should be discussed. Individuals undergoing general anesthesia should stop smoking atleast 8 weeks prior to anesthesia. Smoking increases pulmonary complications.

The anesthesiologist will also ask you to sit up, open your mouth wide and stick out your tongue as far as you can. They will then assign you a Mallampati classification based on what they see. This predicts difficulty of attaining an airway with intubation. Mallampati Class I is an accessible airway with the lowest risk while Mallampati Class IV indicates a crowded airway and the highest risk.

Part of the preoperative surgical assessment involves obtaining a full set of labs. These labs include a complete blood count (CBC), electrolytes, renal function, liver function and coagulation studies (PT and aPTT). A preop patient may also need an electrocardiogram (ECG), chest x-ray, and urine analysis (UA).

All individuals should make a point of discussing their preoperative risk assessment with their physician – before signing the consent for the procedure!