Patients without significant medical problems—especially those under age 50—are at very low risk for perioperative complications. Their preoperative evaluation should include a history and physical examination. Special emphasis is placed on obtaining a careful pharmacologic history and assessment of functional status, exercise tolerance, and cardiopulmonary symptoms and signs in an effort to reveal previously unrecognized disease that may require further evaluation prior to surgery. In addition, a directed bleeding history (Table 3–1) should be taken to uncover coagulopathy that could contribute to excessive surgical blood loss. Routine preoperative laboratory tests in asymptomatic healthy patients under age 50 have not been found to help predict or prevent complications. Even elderly patients undergoing minor or minimally invasive procedures (such as cataract surgery) are unlikely to benefit from preoperative screening tests.
Table 3–1.Directed bleeding history: Findings suggestive of a bleeding disorder. ||Download (.pdf) Table 3–1. Directed bleeding history: Findings suggestive of a bleeding disorder.
Unprovoked bruising on the trunk of > 5 cm in diameter
Frequent unprovoked epistaxis or gingival bleeding
Menorrhagia with iron deficiency
Hemarthrosis with mild trauma
Prior excessive surgical blood loss or reoperation for bleeding
Family history of abnormal bleeding
Presence of severe kidney or liver disease
Use of medications that impair coagulation, including nutritional supplements and herbal remedies
et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016 May;222(5):930–47.
et al. Routine preoperative tests for elective surgery: summary of updated NICE guidance. BMJ. 2016 Jul 14;354:i3292.