Our policy on pre-operative testing

We are often asked what preoperative tests will be required for surgery or why we do not ask for testing required by other offices. This section will give you an overview of our general stance on preoperative testing and examples of some of the most common preoperative tests and who needs them. Keep in mind that the individual requirements for each person will be determined during your consultation history and physical exam and you will be given a copy with your quote or soon afterward. The list below is meant as an example of our guidelines and is not all-inclusive. It is subject to change based on changing medical recommendations or our clinical experience. Rest assured, that we make every effort to make your preoperative experience as smooth as possible while always maintaining the highest medical standard of care.

Why aren’t you asking me to get labs or an EKG or a medical clearance? 

Some of our patients are surprised when they do not require further testing or work up after their consultation. They may have been given a list of requirements at another office or were told by friends or family members that they would have to get this or that test before surgery. Unfortunately, clinical practice often lags quite a bit behind medical research. Our preoperative testing policies are based on the following principles:
  1. Medical Standard of Care: Our anesthesia and surgical providers follow the guidelines of the ASA (American Society of Anesthesiologists), as well as other relevant medical societies and focus groups, which provide a standard of care for preoperative testing based on medical research.
  2. Patient Value: We value your time and know first hand how challenging it is to schedule medical appointments and tests with all the other plans and obligations you have day to day. We also keep in mind the expense to our patients of indiscriminate medical testing, which is often not covered by their insurance plans.
  3. Medical Responsibility: One of the old surgical saws is “Don’t order a test unless you know what you plan to do with the results” and there is wisdom in that statement! Studies have shown that getting tests on healthy low-risk patients which are not based on symptoms or specific risks (like demographics or personal history) is more dangerous than getting no tests at all!  This is because mild lab abnormalities or radiology findings potentially subject them to needless anxiety and further unnecessary testing or biopsies which are ultimately not significant.
  4. Ethics: As patient care providers we all have a responsibility to prevent and correct the gross waste of resources and funds within the American medical system which could go towards needed preventative care and therapy within all of our communities.

Testing Recommendations:

Most Recent ASA task force update:
ASA Pre-Op Guidelines 2012
Summary of pre-op testing recommendations from multiple associations:
PreOp Testing Before Non-Cardiac Surgery

Examples of our current preoperative requirements:

  • Body Mass Index between 18.5 and 40 [CDC BMI Calculator]
  • Current set of vital signs (heart rate and blood pressure and weight) for those who have phone consultations. This may be sent as a copy of your last doctor’s visit or even a print out from a scale and monitor such as those found in many pharmacies.
  • HgbA1C test within 3 months of surgery for diabetic patients with a value of 7.5 or below
  • Mammogram for individuals undergoing breast surgery who are 45 years old and older or have a history of  breast cancer
  • Preoperative risk evaluation, or “clearance” from a primary care provider: patients over 50 years old, including an EKG for those over 55 years old.
  • Blood count: those with a history of anemia or bleeding disorders, moderate to severe kidney or liver disease
  • Serum Electrolytes or “BMP”: moderate to severe kidney or liver disease, those who have undergone full gastric bypass for weight loss, people on diuretic medications

Timing:

You will be given your specific preoperative requirements, if any, at the time of your consultation or just after. We prefer that your tests are not older than three months prior to your surgery; although some tests may be as old as within the past six months or within the past year in the case of mammograms. Your specifics will be communicated after your consultation. We must have your results no later than fifteen days prior to your surgery.