The preoperative history and physical (H&P) helps optimize patient safety and improve surgical outcomes. A thorough H&P helps to identify potential risks, assess comorbid conditions, and plan perioperative management. The decision of when to perform a preoperative H&P depends on several factors, including the type of surgery, the patient’s overall health status, and existing comorbidities.
In general, the timing of preoperative H&P should be guided by the nature and urgency of the surgical procedure. For elective surgery, the H&P is ideally performed several days to a week prior to surgery. This allows sufficient time to address any identified medical issues, such as optimizing chronic conditions or consulting specialists as needed. For urgent procedures, however, the benefits of the H&P must be balanced against the level of emergency and the amount of critical information that can be readily obtained (1).
The preoperative H&P should be tailored to the patient’s age, comorbidities, and specific surgical procedure. Important components include evaluation of the patient’s cardiovascular, pulmonary, and renal status and identification of any history of anesthesia-related complications. Special attention is given to identifying conditions that may affect anesthetic management, such as difficult airway or obstructive sleep apnea, as these factors significantly impact perioperative planning (2).
Cardiovascular assessment is critical, especially in patients with a history of coronary artery disease, heart failure, or significant arrhythmias. American College of Cardiology/American Heart Association guidelines recommend assessment of functional capacity and cardiovascular risk stratification. This may include noninvasive testing or consultation if the patient has significant symptoms or poor functional status (2). Similarly, assessing pulmonary risk is critical, especially in patients with chronic obstructive pulmonary disease or recent respiratory infections. Pulmonary function testing may be indicated in patients with unexplained dyspnea or known chronic respiratory disease (3).
Preoperative laboratory tests should not be routinely performed on all patients but should be guided by individual risk factors and the type of surgery. For example, hemoglobin levels are checked if significant blood loss is expected, while renal function tests are critical in patients with chronic kidney disease. In addition, coagulation profiles may be indicated for patients on anticoagulation therapy or with liver dysfunction (2).
For patients on chronic opioid therapy, recent studies suggest that a detailed assessment of opioid use and its potential impact on postoperative outcomes should be part of the preoperative H&P. Chronic opioid use may complicate postoperative pain management and increase the risk of adverse events (4).
For patients with complex medical histories or undergoing major surgery, multidisciplinary preoperative clinics may be beneficial. These clinics facilitate coordinated evaluations by anesthesiologists, internists, and surgeons to ensure comprehensive risk assessment and optimization (3).
Ultimately, the timing and extent of preoperative H&P depends on balancing a thorough evaluation with the urgency of surgery. Appropriate planning ensures that patient-specific risks are addressed proactively, reducing perioperative morbidity and improving surgical outcomes.
References
- Firde M, Yetneberk T. Preoperative investigation practices for elective surgical patients: clinical audit. BMC Anesthesiol. 2024;24(1):184. Published 2024 May 23. doi:10.1186/s12871-024-02557-y
- Disma N, Asai T, Cools E, et al. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. Br J Anaesth. 2024;132(1):124-144. doi:10.1016/j.bja.2023.08.040
- Rossi M, et al. State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time. J Pers Med. 2024;14(2). doi:10.3390/jpm14020182.
- Gasser L, Lener S, Hartmann S, Löscher WN, Thomé C, Hofer A. Does preoperative opioid therapy in patients with a single lumbar disc herniation positively influence the postoperative outcome detected by quantitative sensory testing?. Neurosurg Rev. 2022;45(4):2941-2949. doi:10.1007/s10143-022-01818-z
