PREOPERATIVE EVALUATION
SURGICAL CATEGORIES AND ASA CLASSIFICATION
PREOPERATIVE TESTING
EKG: (within 6 months)
- age 50 or over, HTN, DM and over 40 with cardiovascular disease
or > 2
risk factors for CAD, significant renal, thyroid, or other metabolic
disease, and surgical category 5.
CHEST X-RAY: (within 1 year)
- Debilitating lung disease or significant worsening in past 6
months; cardiac or thoracic procedure; surgical category 5.
SERUM CHEMISTRIES
(M-7): (within 1 month)- Renal disorders;
adrenal or thyroid disorders; DM, diuretic, chemotherapy or treatment
that may affect chemistries; surgical category 5.
URINALYSIS: (within one month) - DM; renal disorders; G-U procedure;
recent UTI; surgical category 5.
CBC (within one month) - Heme disorder, vascular procedure,
chemotherapy, surgical procedure 5.
COAGULATION STUDIES (immediately
prior) - Anticoagulation Rx, vascular procedure, surgical category
5.
PREGNANCY TEST (within
1 week) - At risk patients for whom pregnancy may complicate the
procedure or uncertain status.
No testing or exam prior to the day of surgery may be required
in some patients: eg, most children, generally healthy adults
<50 with surgical category 1 or 2. (Generally healthy adults
>50 with surgical category 1 or 2 may only require a preoperative
EKG.
SURGICAL CATEGORIES
Category 1 - Minimal risk, minimal
blood loss (ie, minor outpatient procedure
Category 2 - Mild risk, blood loss <500 cc (eg, laparoscopies,
hernias, superficial procedures)
Category 3 - Moderate risk,
blood loss 500 - 1500 cc (eg, joint replacements, open abdominal
surgery)
Category 4 - Major risk, blood loss > 1500 cc (eg, major
spinal surgery, GI, GU and vascular surgery)
Category 5 - Critical risk, blood loss > 1500 cc (eg, cardiothoracic,
intracranial, radical procedures)
ASA CLASSIFICATION
Class 1 - Generally
healthy, localized pathologic process
Class 2 - Stable mild to moderate systemic condition (eg,
smoker, HTN, obesity, PG, DM, asthma, >70)
Class 3 - Moderately severe
systemic disorder (eg, poorly controlled disorders, hx of CAD,
dysrhythmia)
Class 4 - Severe and clearly life-threatening disorder
(eg, recent MI, unstable angina, severe CHF or COPD, hepatic or
renal failure)
Class 5 - Little chance of survival; procedure performed
in desperation.
