Pre-operative Testing

Depending on your surgery, you may be requested to participate in a pre-operative assessment, which can take the form of an in-person appointment with a primary care doctor, a video call, or a telephone call. Most pre-ops do require a physical examination and in office visit as most often a physical exam, ekg and laboratory workup is required. All testing is performed in our office as an outpatient and do not require you to visit multiple places to have it performed.

During this assessment, our health care provider will ask questions about your health, previous medical history, surgical history, allergies, medications and home situation. The decision to order preoperative tests should be guided by the patient’s clinical history, comorbidities , and physical examination findings.

The purpose of the Pre-op or pre-operative assessment is to determine if there are any medical issues that need to be addressed prior to the operation or if you require special attention during perioperative or postoperative surgery. Our Beverly Hills medical practice has been providing preoperative surgical clearances for surgeons and patients prior to surgery for over a decade. We offer in house laboratory workup, treadmill stress test, 2d echo of the heart, pulmonary function testing and more. Contact us today to schedule your consultation and get cleared for your upcoming surgery.

What is pre-operative testing?

Pre-operative testing is a set of medical evaluations, procedures, and assessments that are performed before surgery to prepare a patient for the operation and ensure their safety. These tests help to identify any underlying medical conditions or potential risk factors that may affect the patient’s health during or after the surgery.

The tests can include physical examinations, laboratory tests, imaging studies, and other diagnostic tests, as well as assessments of the patient’s medical history, current medications, and overall health status. These test results help the medical team determine the best course of action for the patient and ensure that the patient is physically and mentally prepared for the operation.

What is the reason for pre-operative testing?

The main reason for pre-operative testing is to ensure the safety and well-being of the patient before, during, and after the surgery. The tests help the medical team evaluate the patient’s overall health, identify any underlying medical conditions, and determine any potential risk factors that may affect the patient’s health during or after the surg. Healthy patients who have no risk factors may still need to have this procedure to ensure safety. This clearance does not need to be done by a cardiologist only. Our board certified internal medicine doctors have extensive experience in optimizing health and uncovering issues that need to be resolved prior to surgery.

Additionally, pre-operative testing can help clinicians:

• Confirm the correct diagnosis and determine the best course of treatment
• Ensure that the patient has informed consent and understands the high risks and benefits of the surgery
• Plan for the best possible outcome of the surgery
• Optimize the patient’s health and reduce the risk of complications during the surgery
• Prepare for any contingencies that may arise during the surgery
• Improve communication between the patient, the medical team, and the family
• Discover any medical issues that would put a patient for risk for surgery and correct them prior to the operation

What does pre-operative testing involve?

According to the American Society of Anesthesiologists, routine preoperative tests are performed without a specific reason and usually consist of a combination of blood tests, urine tests, a chest X-ray, and an Electrocardiogram (ECG). Cardiology testing and cardiac testing is routinely ordered and performed for older patients to ensure good cardiac health.

Complete Blood Count (CBC): This test measures the number of red and white blood cells, as well as the amount of hemoglobin in the blood. This information helps determine if a patient is anemic or if their blood is capable of carrying enough oxygen to the body’s tissues. It is important to have a normal baseline of tests to ensure good health.

Blood Coagulation Tests: Coagulation studies measure the blood’s ability to form clots, which helps to prevent excessive bleeding during surgery. If your platelet count is too high, blood clots can form in your blood vessels. Prothrombin time is used to measure bleeding time and enure adequate clotting in the blood.

Coagulation studies are reserved for patients with a history of bleeding or medical conditions that predispose them to bleeding, and for those taking anticoagulants.

Blood Gases: The blood gases test measures the levels of oxygen and carbon dioxide in the blood, which helps to determine if the patient has any lung or heart problems that might affect their ability to receive anesthesia.

Blood Glucose: This test measures the amount of glucose (sugar) in the blood. High blood sugar levels can indicate diabetes, which needs to be well-controlled before surgery.

Dipstick Urinalysis: This is a simple test that can detect the presence of certain substances in the urine, such as glucose, protein, or red and white blood cells, which may indicate underlying health abnormalities.

Renal Function Tests: These tests measure how well the kidneys are functioning and can help detect any problems that might affect the patient’s ability to receive anesthesia or heal after surgery. This test is usually ordered in a complete metabolic panel and also evaluate any electrolyte abnormalities that may be present.

Anemia Test: Anemia is a condition in which the body does not have enough red blood cells, which can lead to fatigue and weakness. This test helps to determine if a patient has anemia and, if so, the severity of it.

Pregnancy Test: For women of childbearing age, a pregnancy test is usually performed to ensure the safety of the fetus and the mother during surgery.

Lung Function Tests: These tests evaluate how well the lungs are working and can detect any respiratory problems that might affect the patient’s ability to receive anesthesia.

Chest X-ray: A chest X-ray can detect any lung problems, such as pneumonia or lung tumors, that might affect the patient’s ability to receive anesthesia.

Electrocardiogram (ECG): Measures the electrical activity of the heart and can detect any heart problems that might affect the patient’s ability to receive anesthesia.

Echocardiography: Echocardiogram uses ultrasound to check for anomalies in the heart’s structure

MRSA Screening: MRSA (methicillin-resistant Staphylococcus aureus) is a type of bacteria that can cause infections. This screening test helps to determine if the patient has MRSA, which can pose a risk for complications during surgery.

Creatinine Test: A creatinine test is used to see if your kidneys are working normally. It’s often ordered along with another kidney test called blood urea nitrogen (BUN) or as part of a comprehensive metabolic panel (CMP).

Treadmill cardiac stress test: Our office is equipped with treadmill cardiovascular stress testing for patients who need further workup to ensure they are in optimal cardiac health prior to surgery. A stress test requires walking on a treadmill while blood pressure, heart rate, and signs of arrhythmia and coronary artery disease are monitored.

Post-operative complications

Postoperative complications refer to any negative outcomes or issues that occur after a surgical procedure. These can range from minor issues, such as pain and infection, to more serious complications, such as blood clots, organ failure, or adverse reactions to anesthesia. It’s important to monitor a patient’s recovery after surgery closely and to address any complications promptly to ensure a successful outcome. Guidelines for the management of common postoperative complications including acute kidney injury, gastrointestinal complications, postoperative anemia, fever, and delirium are discussed in the medical literature at length.

Who needs pre-operative testing?

Pre-operative testing is usually recommended for patients who are scheduled to undergo surgery. The purpose of pre-operative testing is to identify any underlying health issues that may affect the patient’s ability to undergo surgery or that may require treatment prior to surgery.

The extent of pre-operative testing depends on various factors such as the patient’s age, overall health, type of surgery, and the anesthesiologist‘s recommendation. In some cases, preoperative laboratory testing may not be necessary for low-risk procedures, while in others, a more comprehensive battery of tests may be required.

Types of Surgery

Cardiovascular surgery: Heart surgery, including coronary artery bypass, valve replacements, and heart transplant.

Non-Cardiac surgery: Non-cardiac surgery refers to any type of surgery that does not involve the heart or major blood vessels. This includes orthopedic surgery, gastrointestinal surgery, and gynecologic surgery.

Orthopedic surgery: Surgery of the musculoskeletal system, including joint replacements, spinal surgery, and sports medicine.

Neurological surgery: Surgery of the brain and nervous system, including brain tumor removal, spinal cord procedures, and epilepsy surgery.

Cancer surgery: Surgery to diagnose, stage, or treat cancer, including biopsies, lumpectomies, and mastectomies.

Ophthalmic surgery: Surgery of the eye, including cataract surgery, corneal transplants, and laser eye surgery.

Elective Surgery: Elective surgery is a planned or scheduled surgical procedure that is not performed in response to an emergency situation.

Gastrointestinal surgery: Surgery of the digestive system, including appendix removal, hernia repair (low-risk surgery), and gastric bypass.

Reproductive surgery: Surgery of the reproductive system, including hysterectomies, tubal ligations, and vasectomies.

Plastic surgery: Reconstruction or cosmetic surgery, including facelifts, tummy tucks, and breast augmentations.

Bariatric surgery: Weight loss surgery, including gastric bypass, sleeve gastrectomy, and gastric banding.

Trauma surgery: Surgery to treat injuries, including fractures, lacerations, and internal injuries.

Vascular Surgery: Vascular surgery is a type of surgery that involves the treatment of conditions affecting the circulatory system, including arteries and veins.

What are the steps in pre-operative preparation?

The steps in pre-operative preparation can vary depending on the type of surgery and the individual’s health status but generally include the following:

Consultation with the surgeon: This is an opportunity for the patient to ask questions and get information about the procedure, including what to expect before, during, and after surgery.

Medical evaluation: The patient may undergo a physical examination and laboratory tests to assess their general health and identify any underlying medical conditions that need to be managed before the surgery.

Anesthesia evaluation: The patient will meet with the anesthesiologist to discuss their medical history, allergies, and any other relevant information to determine the best anesthesia approach for their procedure.

Pre-operative instructions: The patient will receive instructions on how to prepare for the surgery, including dietary restrictions, medications to take or avoid, and any other important information.

Admission to the hospital: The patient will arrive at the hospital on the day of the surgery and undergo any final pre-operative tests and preparations.

What assessments are most critical in the pre-operative period?

The preoperative evaluation process should always include a comprehensive history and physical examination with a focus on identifying potential cardiac and pulmonary risks, as well as assessing the patient’s functional capacity.

What are some risk factors for surgery?

There are many risk factors that can increase risk during surgery and increase risk of morbidity. The most common ones include:

• Obesity
• Age
• Smoking history
• Bleeding disorder
• Sleep apnea
• Uncontrolled blood pressure
• Uncontrolled diabetes
• History of airway disease
• History blood clots and DVT
• History of airway disease such as asthma, COPD, and any other airway disease
• History of coronary artery disease
• Kidney problems
• History of alcohol and illegal drugs
• History of stroke
• Difficulty with anesthesia and post recover

Please contact our office today to schedule your pre-op exam. We will do a thorough evaluation to make sure you are fit and ready for your surgery day and optimize any conditions that can put you at risk. We look forward to seeing you in our office.

Pre-operative testing near me

MyconciergeMD offers the best pre-operative testing near me in Beverly Hills but can also come to your home or office throughout the Los Angeles area. We serve patients near Beverly Hills, Bel Air, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Redondo Beach, Downtown Los Angeles, Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Silverlake, Echo Park, and many more.

References:

1. Feely MA, Collins CS, Daniels PR, Kebede EB, Jatoi A, Mauck KF. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician. 2013;87(6):414-418.

2. Practice Advisory for Preanesthesia Evaluation: An Updated Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2012; 116:522–538 doi: https://doi.org/10.1097/ALN.0b013e31823c1067

3. Feely MA, Collins CS, Daniels PR, Kebede EB, Jatoi A, Mauck KF. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician. 2013;87(6):414-418.

4. “Creatinine Test,” Medlineplus.gov, 2014. https://medlineplus.gov/lab-tests/creatinine-test/ (accessed Feb. 12, 2023).

‌5. Zambouri, A. (2007). Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia, 11(1), 13-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464262/

6. Stephenson C, Mohabbat A, Raslau D, Gilman E, Wight E, Kashiwagi D. Management of Common Postoperative Complications. Mayo Clin Proc. 2020 Nov;95(11):2540-2554. doi: 10.1016/j.mayocp.2020.03.008. PMID: 33153639.