3-03: Preoperative Evaluation of the Asymptomatic Patient

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; emphasis should be on a pharmacologic history and assessment of functional status, exercise tolerance, and cardiopulmonary status to look for 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.