Presurgical or preoperative testing is the preparation and management of a patient before surgery.
Presurgical testing psychologically and physically prepares a patient for surgery.
The U.S. Department of Health and Human Services' National Center for Health Statistics reported more than 40 million inpatient surgical procedures (requiring an overnight hospital stay) performed in the United States in 2000. Data from 1996 indicates more than 30 million outpatient surgical procedures (in which the patient goes home the same day of surgery) were performed.
Obstetrical, cardiovascular, digestive, musculoskeletal, and nervous system surgeries were among the majority of the inpatient surgical procedures performed. The majority of outpatient surgeries were performed on the digestive system, eyes, musculoskeletal system, female reproductive organs, and urinary system.
A planned surgery usually involves a surgical consultation, presurgical testing, the surgery itself, and recovery at home.
During the surgical consultation, the patient meets with the surgeon or a member of the surgeon's health care team to discuss the surgery and other potential treatment options for the patient's medical condition. A thorough review of the patient's medical history and a complete physical exam are performed at this time. The medical review includes an evaluation of the patient's previous and current medical conditions, surgeries and procedures, medications, and any other health conditions, such as allergies, that may impact the surgery.
The surgical team will ensure that the patient understands the potential benefits and risks of the procedure. Patient education may include one-on-one instruction from a health care provider, educational sessions in a group setting, or self-guided learning videos or modules. Informative and instructional handouts are usually provided to explain specific pre-surgical requirements.
After attending the surgical consultation, the patient may desire to seek a second opinion to confirm the first doctor's treatment recommendations.
Presurgical testing, also called preoperative testing, includes a variety of tests, patient education, and meetings with the health care team to inform the patient about what to expect before the procedure and during the recovery. Presurgical testing is generally scheduled within one week before the surgery.
Several tests are performed before surgery to provide complete information about the patient's overall
- blood tests
- urine tests
- chest x rays
- pulmonary function tests
- computed tomography scan (CT or CAT scan)
- heart function tests that may include an electrocardiogram or echocardiogram
If the patient recently had these tests performed (within the past six months), he or she can request the test results be forwarded to the surgical center.
Before some surgical procedures, such as valve surgery, a complete dental exam is needed to reduce the risk of infection. Other precautions will be taken before the surgery to reduce the patient's risk of infection.
Informed consent is an educational process between health-care providers and patients. Before any procedure is performed, the patient is asked to sign a consent form. Before signing the form, the patient should understand the nature and purpose of the diagnostic procedure or treatment, the risks and benefits of the procedure, and alternatives, including the option of not proceeding with the test or treatment. During the discussion about the procedure, the health care providers are available to answer the patient's questions about the consent form or procedure.
Advance directives are legal documents that increase a patient's control over medical decisions. A patient may decide medical treatment in advance, in the event that he or she becomes physically or mentally unable to communicate his or her wishes. Advance directives either state what kind of treatment the patient wants to receive (living will), or authorize another person to make medical decisions for the patient when he or she is unable to do so (durable power of attorney).
Advance directives are not required and may be changed or canceled at any time. Any change should be written, signed, and dated in accordance with state law, and copies should be given to the physician and to others who received original copies. Advance directives can be revoked either in writing or by destroying the document.
Advance directives are not a do-not-resuscitate (DNR) order, which indicates that a person—usually with a terminal illness or other serious medical condition—has decided not to have cardiopulmonary resuscitation (CPR) performed in the event that his or her heart or breathing stops.
Patients who will undergo any surgical procedure are encouraged to quit smoking and stop using tobacco products at least two weeks before the procedure, and to make a commitment to be a nonsmoker after the procedure. Quitting smoking before surgery helps the patient recover more quickly from surgery. There are several smoking cessation programs available in the community. The patient should ask a health care provider for more information if he or she needs help quitting smoking.
The presurgical evaluation may include meetings with the anesthesiologist, surgeon, nurse clinicians, and other health care providers who will manage the patient's care during and after surgery, such as a dietitian, social worker, or rehabilitation specialist.
The patient's surgery time may not be determined until the business day before the scheduled surgery. The patient may be instructed to call the surgical center to find out the time of the scheduled surgery.
Patients are told to come to the surgery center far enough in advance (usually about two hours prior to the scheduled surgery time) so they can be properly prepared for surgery. In some cases, the patient's surgery may need to be rescheduled if another patient requires emergency surgery at the patient's scheduled time.
Some surgery centers offer services such as guided imagery and relaxation tapes, massage therapy, or other complementary techniques to reduce a patient's level of stress and anxiety before a surgical procedure.
Guided imagery is a form of focused relaxation that coaches the patient to visualize calm, peaceful images. Several research studies have proven that guided imagery can significantly reduce stress and anxiety before and after surgical and medical procedures and help the patient recover more rapidly. Guided imagery tapes are available at many major bookstores and from some surgery centers. The patient listens to the guided imagery tapes on his or her own CD or tape player before and after the surgery. The patient may even be able to continue listening to the tapes during the procedure, depending on the type of procedure being performed.
Blood transfusions may be necessary during surgery. A blood transfusion is the delivery of whole blood or blood components to replace blood lost through trauma, surgery, or disease. About one in three hospitalized patients will require a blood transfusion. The surgeon can provide an estimate of how much blood the patient's procedure may require.
To decrease the risk of infection and immunologic complications, some surgery centers offer a preoperative blood donation program. Autologous blood (from the patient) is the safest blood available for transfusion, since there is no risk of disease transmission. Methods of autologous donation or collection include:
- Intraoperative blood collection: The blood lost during surgery is processed, and the red blood cells are reinfused during or immediately after surgery.
- Preoperative donation: The patient donates blood once a week for about one to three weeks before surgery. The blood is separated, and the blood components needed are reinfused during surgery.
- Immediate preoperative hemodilution: The patient donates blood immediately before surgery to decrease the loss of red blood cells during surgery. After donating, the patient receives fluids to compensate for the amount of blood removed. Since the blood is diluted, fewer red blood cells are lost from bleeding during surgery.
- Postoperative blood collection: Blood lost from the surgical site right after surgery is collected and reinfused after the surgical site has been closed.
The surgeon determines what type of blood collection process, if any, is appropriate.
Depending on the type of surgery scheduled, certain medications may be prescribed or restricted before the surgery. The health-care team will provide specific guidelines. If certain medications need to be restricted before surgery, the patient will receive a complete list of the medications (including prescription, over-thecounter, and herbal medications) to avoid taking before the scheduled surgery.
Prescribed medications that need to be taken within 12 hours before surgery should be swallowed with small sips of water.
Before most surgeries, the patient is advised not to eat or drink anything after midnight the evening before the surgery. This includes no smoking and no gum chewing. The patient should not drink any alcoholic beverages for at least 24 hours before surgery, unless instructed otherwise.
Most patients are admitted to the surgery center or hospital the same day as the scheduled surgery. The patient should bring a list of current medications, allergies, and appropriate medical records upon admission to the surgery center.
The patient should arrange for transportation home, since the effects of anesthesia and other medications given before surgery make it unsafe to drive.
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American College of Surgeons. 633 N. Saint Clair Street, Chicago, IL 60611-3211. (312) 202-5000. <http://www.facs.org/>.
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Angela M. Costello