Pre-op workup
Formal Definition
The preoperative medical evaluation process to assess a patient's fitness for anesthesia and surgery, identify and optimize modifiable risk factors, and fulfill anesthesia and surgical team requirements; includes history, physical examination, indicated laboratory and diagnostic studies, cardiac risk stratification (ACC/AHA guidelines), and subspecialty clearance when appropriate.
How It's Used on the Ward
"Pre-op workup" or "clearing the patient for surgery" — the medical assessment required before going to the OR.
Example
""65-year-old with DM and hypertension scheduled for elective hip replacement: pre-op workup ordered — CBC, BMP, coags, EKG; A1C to assess DM control; cardiology clearance given 3 METs functional capacity; hold metformin 24h before for contrast risk; A1C 8.2 — surgery team notified, optimizing glycemic control.""
Clinical Context
ACC/AHA 2014 guidelines govern cardiac pre-op evaluation: step-wise risk assessment based on urgency, functional capacity (METs), and revised cardiac risk index (RCRI). Routine testing (CBC, BMP, EKG) in healthy patients under 50 without symptoms is low-yield and no longer recommended — test based on clinical indication. RCRI factors: coronary artery disease, CHF, CVA/TIA, DM on insulin, Cr >2.0, high-risk surgery — 0-1 factors = low risk, proceed; 2+ factors = calculate perioperative risk. Anticoagulation bridging: consult hematology or pharmacy for complex cases. Hold anticoagulants, antiplatelets per procedure and bleeding risk. NPO guidelines: solid food 8h, light meal 6h, clear liquids 2h before induction (ASA guidelines).
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