QUEEN’S UNIVERSITY

DEPARTMENT OF ANESTHESIOLOGY
 

 

 


SUBJECT:     Guidelines for Preoperative Testing prior to Elective Surgery

ISSUED BY:

APPROVED BY:

 

NUMBER                      

PAGE                             1 of 2

ORIGINAL ISSUE          10.2003

REVIEW                        10.2003

REVISION                     

 

Introduction:

Laboratory investigations should be ordered only when indicated by the patient’s medical status, drug therapy, or the nature of the proposed procedure.  Investigations should not be ordered on a routine basis1.”  Best evidence suggests that laboratory investigations done without indication are of no clinical value2.

 

Definition:

Preoperative laboratory investigation refers only to those tests required to assess the patient’s fitness to undergo anesthesia and surgery. Testing done to guide surgical management, stage surgical disease, or rule out metastatic disease should be ordered by the physician and may be completed as part of the Pre-surgical screening visit.

 

Surgeons are encouraged to order those tests necessary for surgical indications. Ordering tests “for the anesthesiologist” should be avoided. A medical directive, based on patient and procedure indications, written by the Department of Anesthesiology will determine the preoperative laboratory investigations required for the anesthesiologist. The nurse performing the pre-surgical patient assessment will order these preoperative tests based on the medical directive.

 

Policy:

1.1     Complete Blood Count (CBC)

1.1.1          Major surgery in which a group and screen will be required.

1.1.2          Known or suspected anemia, bleeding disorder, or bone marrow suppression

1.1.3          A current diagnosis of malignancy.

1.1.4          Chronic cardiovascular, respiratory, hepatic or renal systems disease.

1.1.5          Sickle cell risk

1.1.6          Age less than one year.

1.1.7          Autologous blood donors (to be repeated day of surgery)

1.2    Activated partial thromboplastin time (aPTT) and INR

1.2.1          Therapy with heparin or warfarin (to be repeated day of surgery)

1.2.2          Bleeding disorder or history of excessive bleeding or bruising.

1.2.3          Hepatic disease, excessive alcohol use, poor nutritional status

1.3    Serum chemistry (sodium, potassium, chloride, creatinine, urea)

1.3.1          Renal disease

1.3.2          Hypertension

1.3.3          Diabetes mellitus, pituitary, or adrenal disease

1.3.4          Therapy with diuretics, digoxin, angiotension-converting enzyme inhibitors, lithium carbonate, corticosteroids, nonsteroidal anti-inflammatory medications.

1.4    Blood glucose

1.4.1          Diabetes mellitus

1.4.1.1     Fasting glucose repeated on the day of surgery.

1.5    Sickle Cell Screen

1.5.1          Genetically susceptible individuals (Africa, Caribbean, Saudi Arabia)

1.5.2          Hemoglobin electrophoresis if sickle cell screen is positive

1.6    Pregnancy test (serum β-HCG)

1.6.1          Women of childbearing years if pregnancy is suspected or if the patient is unsure

1.7    Liver enzymes (AST, ALP, bilirubin)

1.7.1          Hepatic disease,

1.7.2          Excessive alcohol use

1.7.3          Recreational drug abuse

1.8    Group and Screen or Cross match

1.8.1          To be determined by the Surgical Blood Order Schedule (see Appendix I)

1.9    Electrocardiogram (ECG)

1.9.1          Cardiac dysrhythmia, pacemaker, automated implantable defibrillator

1.9.2          Coronary artery disease, valvular heart disease, congenital heart disease

1.9.3          Hypertension, diabetes mellitus,

1.9.4          Peripheral vascular disease

1.9.5          Chronic pulmonary disease

1.9.6          Cerebrovascular accident, TIA

1.9.7          Age 65 or greater

1.10 . Urinalysis

1.10.1      Suspicion of active urinary tract infection

1.11 Chest Radiograph

1.11.1      Acute deterioration in pulmonary disease

1.11.2      Current congestive heart failure

1.11.3      Cardiac and thoracic surgical procedures

1.11.4      At the discretion of the surgeon for investigation of metastatic disease

1.12  Cervical Spine Flexion and Extension Radiograph

1.12.1      History of Rheumatoid arthritis and no cervical spine x-ray within the last year.

 

2.       Cataract Surgery procedures

2.1.1          Evidence from a prospective, randomized, controlled clinical trial indicates that preoperative testing of the patient undergoing cataract surgery is of no clinical value3.

2.1.2          No preoperative testing will be ordered unless the treating physician suspects an acute medical problem.

2.1.3          Diabetic patients taking insulin or oral hypoglycemic medications will have a fasting blood sugar on the day of surgery.

 

3.       Laboratory testing done within the interval specified below will be considered valid and need not be repeated prior to surgery (assuming there has been no change in health status since testing).

3.1.1          CBC, PTT, INR – 3 months

3.1.2          Serum chemistry – 3 months

3.1.3          Type and screen – 6 weeks

3.1.4           Electrocardiogram – 3 months

 

 

References:

 

1.       2001 CAS Guidelines to the practice of anesthesia. Can J Anesth 2001;48(9 Supplement)

2.       Munro J, Booth A, Nicholl J. Routine preoperative testing: a systematic review of the evidence.  Health Technology Assessment  1997;1(12)

3.       Schein OD, Katz J, Bass EB, Tielsch JM, Lubomski LH, Feldman MA, Petty BG, Steinberg EP. The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery.  NEJM  2000;342(3):168-75.