What
preoperative laboratory studies should be obtained before surgery?
For an ambulatory surgery unit that is
affiliated with or attached to a hospital, clinical laboratory testing
guidelines should be identical to those required by the related institution.
It has been well established that shotgun, nonselective screening batteries of
both laboratory, radiographic, and other studies yield an extraordinarily low
rate of abnormal findings, few of which may have a significant impact on
patient management. Patients scheduled for surgery should have preoperative
testing ordered with selectivity and based only on a screening including a
careful history and physical examination. In fact, indiscriminate ordering of
tests can have potentially serious and deleterious conse-quences. To explain
abnormal results, additional series of tests may be obtained. Some invasive studies
have inherent dangers. Often, abnormalities are simply ignored, creating a
potential medicolegal liability. Indiscriminate screening often reveals
abnormalities that fail to have any relevance to either the surgery or the
choice of anesthetic agent or technique. Some centers use handheld computers to
obtain the patient history. Branching lines of questioning depend-ent on
previous answers allow extensive information to be gathered. At the conclusion
of the interactive interview, the computer can provide a detailed printout of
significant findings in the history and recommend the preoperative testing to
be obtained. Many facilities do not require any preoperative testing for
superficial surgical procedures on otherwise healthy men and women below the age
of 40–50 years.
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