What is the Purpose of Pre-Operative Assessment and Why Is It important?

When you are required to undergo surgery, a physician at a Michigan-based internal medicine clinic will schedule you for a pre-operative assessment. As the name suggests, it is a process that evaluates the patient’s current health status before the surgery. The assessment aims to see whether the patient is fit for operation or not.

Pre-operative Assessment And What You Need To Know About It?

A pre-operative assessment helps the primary care physician to identify the onset or existence of any co-morbidities that might lead to any difficulties in the anesthetic, surgical and post-operative procedure. The assessment takes place 2-4 weeks before the surgery.

It includes the history and physical evaluation of health determinants such as cardiac, pulmonary, and other body functions. The goal of the evaluation is to get an insight into the patient’s functional capability and tolerance for the operative procedure.

Pre-operative Assessment And Do You Even Need It?

Whether you need to undergo a pre-operative assessment or not is determined by a Physical Status Classification System (ASAPS). The classification approach is developed by the American Society of Anesthesiologists (ASA) to assess the physiological and health status of the person scheduled for surgery. ASAPS categorizes individuals in the following categories,

1. ASA 1:

   Includes a normal, healthy individual (non-smoker, good exercise), with BMI less than 30.

2. ASA 2:

   Include a normal individual with a mild systemic but well-controlled disease with no limitations.

3. ASA 3:

   Includes patients with mild systemic disease that is non-threatening but renders some functional limitations.

4. ASA 4:

   Includes patients with a severe, life-threatening disease that leads to severe functional limitations.

5. ASA 5:

   Includes patients that are not likely to survive the next 24 hours without the scheduled operation.

Patients that belong to ASA 1 and 2, have a mortality rate of 0.1-0.2 respectively and do not require a pre-operative assessment, contingent upon the approval of their physician. However, patients belonging to ASA 3 and above, are required to appear for a pre-operative assessment by their physician.

The Procedure of Pre-Operative Assessment and What Happens During the Process?

Although the anesthetic and surgical protocols vary from patient to patient, the pre-operative assessment remains the same for everyone. The pre-operative assessment occurs in three distinct phases i.e.

Pre-Operative History

The information-gathering protocol during this stage is the same as the routine history-taking process. During this stage, seven different aspects of patient history are recorded;

History of presenting complaint

Here, the physician records the reason why the patient is scheduled for the surgery and the procedure that would be employed.

Past medical history

A detailed past medical history (PMH) is recorded. The physicians ask questions regarding:

Cardiovascular disease

The primary care provider inquires about conditions such as hypertension and stress tolerance post-exercise. The history helps physicians to evaluate the performance of the cardiovascular system. Furthermore, it also helps them to predict the chance of an acute event during anesthesia to reduce any post-operative complications.

Respiratory disease

The primary health care provider inquires whether the patient can lie flat for a prolonged time, experience chronic cough, or possess a risk for obstructive sleep apnea. Moreover, smokers and patients with COPD for lung function and capacity. Since anesthesia requires adequate oxygenation and ventilation, these questions help doctors to prevent the chance of an acute ischemic attack during the operation.

Renal disease

Here, the physician evaluates the baseline renal function of the patient and whether they are taking any kidney-related drug. Since factors like anemia and electrolyte imbalance can cause perioperative complications, it is important to assess the functioning of the kidneys.

Endocrine disease

Diseases such as diabetes mellitus and thyroid need active management during the perioperative procedure.

Gastroesophageal function

GERD, a common gastroesophageal condition, can decrease the anesthetic technique and hence its efficacy. The physician confirms whether the patient takes over-the-counter drugs and if the condition is well-managed or not.

Nutritional assessment

A malnourished patient is more prone to surgical morbidity and mortality. To manage the condition, physicians usually prescribe the use of nutritional supplementation that can be administered orally or by the parenteral or eternal route.

Other factors

Questions related to pregnancy and conditions like sickle-cell anemia to customize the perioperative according to the patient’s status.

Past surgical history

Such history tells whether a patient has undergone surgery in the past or not. If yes, then it gives an insight into their tolerance levels and also alters the ease of operation and anesthesia techniques.

Past anesthetic history

Such history helps to evaluate the patient’s tolerance for anesthesia and how they have responded to it in the past.

Medication history

Drug history helps doctors decide whether they need to alternate or stop medication prior to the treatment.

Family history

Malignant hyperthermia is a genetic condition that can cause complications during the anesthesia process. The physician records family history to evaluate the risks of hereditary factors.

Social history

Social factors such as smoking, alcohol intake, and other lifestyle questions also help detect potential risks.

Other factors such as language contribute to the arrangement of an interpreter.

Pre-Operative Examination

This phase consists of:

1. General examination – for the identification of an underlying pathological condition)
2. Airway examination – to determine the difficulty of intubation and airway assessment using Mallampati’s score

Pre-Operative Testing

Pre-operative testing depends on co-morbidities and the nature of the procedure. People scheduled for minor surgery, who do not have a history of comorbidities, do not require this step. However, in other cases, the following tests are conducted:

1. Complete blood count
2. Complete metabolic panel
3. Clotting screen
4. Blood typing
5. Echocardiogram
6. Chest X-ray
7. Pulmonary function tests (PFT)

The Purpose of Pre-Operative Assessment and Why Is It Important?

A pre-operative assessment does not rule out the possibility of surgery, but it does render the following advantages:

Minimize the risk of complications

During the assessment, the primary care provider records various kinds of history. Be it past medical, anesthetic, surgical, or family history, the information helps the doctors evaluate whether the patient is at risk of any complications. Therefore, during the operation, there are lesser chances of any complications and better chances of recovery.

Helps diagnose and underlying disease

The pre-operative testing that involves various lab tests, may lead to the discovery of undiagnosed medical conditions that could’ve caused complications later. In such cases, the doctor may extend the date of the surgery to treat those conditions first.

Helps get the right treatment

In case of multiple co-morbidities, the primary care physician may refer you to various specialists for better diagnosis and management.

Beneficial for elderly patients

While young patients may not require a pre-operative assessment, it is the elderly that benefit the most from it. As the age increases, a person is at a greater risk of surgical mortality and morbidity. Hence, with the help of lab exams, the physician can better manage the perioperative procedures of the elderly.

Saves money and time

When the physician is well-aware of the patient’s condition, he/she prepares all the resources that are needed to manage any complication which may arise during the operation. This in turn, not only saves time, manpower, and other resources but also the patient’s life during the surgical procedure.

However, to get the most out of your pre-operative assessment please make sure that you are researching and approaching a hospital that has professionals specializing in not only conducting such assessments but also in their field.