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Preoperative Clearance for Noncardiac Surgery

Jonathan Settle, MD and Andrew Buelt, DO
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Reflexive ordering of the pre-op  “everything panel” might not be such a good idea.

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Jorge P. -

nice review. however I was wondering about urinalysis before prosthesis. My understanding was that There is no evidence that asymptomatic bacteriuria results in complication of prosthesis implantation. I found this two articles http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4305141/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690738/
So urinalysis is really needed before prosthesis surgery or not? Could you please clarify? thank.

Katherine G. -

The one thing I would bring up for discussion is the use of the word 'clearance.' I feel as an internist, my job is not to "clear" patients for surgery (interpreted, perhaps, by surgeons as 'okay for surgery'), but rather risk stratify and optimize patients prior to an invasive procedure based on their co-morbidities. When I write my pre-op eval notes for the surgeons, I usually use specific phrasing, such as "This patient is low risk for moderate risk surgery" or refer to the percent risk of serious cardiovascular or pulmonary events. I never use 'cleared.'

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Feeling Restless Full episode audio for MD edition 198:53 min - 93 MB - M4AHippo Primary Care RAP August 2016 Summary 784 KB - PDF

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