Pre-op exam

I have never had a pre-op physical but am interested in what that involves and under what circumstances. I have never had major surgery so maybe pre-op physicals are only for surgery that will require an extended hospital stay. Are these done at a doctor's office or at the hospital? Same as a regular physical exam or not as thorough?

I never had a pre op exam but when I went into the hospital I had to have tests like urine, blood and chest x-ray.

I think they can be relatively thorough. During my yearly physical I obtained a referral to a surgeon for a consultation. By the time it was all said and done the surgeon had recommended I have an operation. I had to have a preoperative physical exam because more than 30 days had lapsed since my yearly exam. My doctor did not feel it was necessary to administer another physical so all that happened was a brief exam along with an EKG and some blood work. Your situation could be entirely different.

A preoperative exam is focused on the problem area and also cardiovascular health and airway. Nothing else is important. It's an entirely focused exam. Since the problem area is well documented by the time the exam is done it's only the latter two things which matter. The accompanying labs are blood count, electrolytes, renal function, urinalysis,EKG and chest X-ray. No one cares about genital or hernia exams unless that's the area to be operated on.

Thanks liquidsky for a good answer.

I can narrow it down more than that even. A pre-op physical is done for exactly one reason. They want to know if you might die on the table or not.

Mashie

That's about it isn't, Mashie? Who cares about the fingers and toes, the neurological, the rectal, the family jewels. We just want to know about the heart, lungs and airway. Also to make sure you aren't diabetic or in renal failure. Nothing else matters much. Oh if you're having bowel surgery we want to make sure you're empty and clean. Sorry no enemas, just golytely and oral antibiotics. Don't want any explosions when we use the bovie cautery unit. We don't want you vomiting and aspirating either. So it's NPO after midnight. It would wreck our numbers.

Liquid, you know I have a lot of respect for you as my medical superior. I am not real good at interpreting sarcasm in black and white, so if you were being sincere, I apologize. With that being said...

Liquid, you said it yourself, the problem for which they are going in to have fixed has been very well documented and all are on the same page. As far as the directions a patient needs to follow prior to surgery will vary depending on the surgeon, and the patient wouldn't be receiving that information from the doctor performing the pre-op physical. If the patient is a diabetic everyone will already know that as well. When you go see the specialist all of that is discussed already. You can bet your bottom dollar the surgeon is going to have all that information anyway, after all, in order to see a specialist you have to have a prior auth done, then the primary doc sends over the needed parts of the chart to the specialist, which if I am not mistaken, would contain information like whether or not the patient is a diabetic or as you suggest, in renal failure.

The primary, at least here never gives patients any sort of pre-op directions because surgeons are usually very particular in what they want, aside from the basics i.e. no food or drink after midnight etc. Now, not always, but almost always the primary doctor knows the patient pretty well, after all, they are the ones who made the referral in the first place. So, the problem has been established and addressed and is now in the hands of the surgeon.

Which leaves us with what? We can cut back to the basics on this one which would be the ABC's no? Airway, Breathing, and Circulation. If one of these isn't as it should be the patient dies. So, the pre-op patient is in the exam room of his primary. The surgical problem is off the table and being handled by the surgeon. The function of the primary's exam is to make sure that the patient will be able to have the surgery and wake up when the surgeon is done right? It's called a pre-op clearance, not a yearly physical.

Again, here might be different than there, but here the surgeon after seeing his patient initially will send them for the blood work that HE wants to see the results of. So again, blood work usually isn't ordered from the primary. Both the primary and the surgeon will receive copies of that blood work and if there was a problem it probably would have already been addressed, if not then the primary might address it during the pre-op clearance if it matters. And no, it doesn't always matter.

So back to the primary again, he will check the blood pressure, listen to the heart and lungs. His job is to make sure that you are healthy enough at that time to have surgery. He will ask the patient if they have any questions, problems, and or concerns. In order to make a diagnosis 90 percent of the information that is needed is in the patients history. As an ER doc you don't usually have that luxury, however the primary will and usually the surgeon also will because the patients history should be part of what is faxed over in the patients chart.

So that means that both doctors will already know if the patient has a history of heart disease, diabetes, renal failure, hang nails, what they are allergic to, their current medication list and whatever else. It doesn't need to be addressed again. Everything that is needed is in the patients history. The primary's job during a pre-op clearance exam is to make sure that the patient can and will handle the surgical procedure and come out of the OR still breathing.

Mashie

Nice, if somewhat snarky answer to Mashie, Sky. (I hope it wasn't meant to sound that way. It's late, I'm in the middle of board review, maybe I'm being over sensitive. I hate board review.)

In fact, what I'm asked to do when I do a surgical pre-op exam, is to sign off that the patent is of acceptable risk to undergo the surgery. In essence, not die from a foreseeable risk from the surgery or the anesthesia. Mashie isn't all that far off (although, I also detect a bit of snarkiness there, too.. Sorry sweetheart..)

Fingers and toes? Maybe if they have a circulatory compromise that makes them either a high risk because of poor vascular condition or clubbing from advanced COPD, otherwise nope, not really relevant. Rectal exam? Nope, sorry, not relevant either.

Neurological? Mentioning conditions that affect anesthesia in the history is part of a complete pre-op note. Most neurological conditions are not contraindications to surgery, though.

Family jewels? Not sure how they affect surgical or anesthesia risk.

For our non-medical friends on the list, the labs are looking for liver and kidney status, because those two organs support metabolizing and eliminating anesthetics, and the anesthesiologists approach to keeping you alive through and after surgery will be tempered by the results of these tests. Blood counts, tests for ability of your blood to clot, are all important to making sure you come out of surgery ok. Testing for diabetes because you can't fight infection or heal wounds with elevated blood sugars.

I don't know a single surgeon that puts their "numbers" above their patients. I knew OF a couple of high profile cardiac surgeons when I was in med school that advertised their "numbers".. But would not accept high risk patients for surgery. One of the best surgeons I ever had the privilege of scrubbing with had crappy "numbers", because he would take cases nobody else would touch, who would definitely die without surgery. He worked hard, and saved some of them, but they really hurt his "numbers".

Regards top you both, and to the rest of our friends on the board,

Doc

I apologize for being snarky because I've been overwhelmed a bit too. Of course it's serious business. Sometimes I'm just too much of a wiseass.

No need to apologize Liquid, but thank you very much. I too am a tad on the cranky side this evening as I think I am headed back to the hospital if my problem doesn't resolve itself. I am sure I came across like I was minimizing, or maybe being disrespectful of a doctors knowledge, or not adequately expressing the need for, or the importance of a pre-op exam.

My first post in this thread where I gave you the short of it wasn't at all geared towards you or any other medical professional, but to the others who don't always understand why if you are in there for a pre-op physical then why didn't the doctor do a rectal and what not. The OP almost sounded as if he feels he was cheated on, and like wondering why he didn't get a real physical.

I am a "have to see the picture first before I can do the puzzle" type of a person. I have to know why or what the point is, what's the goal. Once I have a finish line to focus on, the rest is irrelevant. My post cann't get any more basic, to the point, or this is the end goal than it is. Most patients don't care that they are having this blood test done or for what reason as part of their pre-op work up.

They simply want to know that these tests and pre-op physical determines whether or not they are fit for surgery and will they wake up when it's all done.

Mashie

My last pre-op exam was in 1962 at Children's Hosp. I went in the day before surgery. A team of orthopedic residents came in and did all the usual. Took my blood, pee'd in a cup. Later, student nurse gave me an SSE. A tech. came in and shaved my foot and leg.

Last big surgery I had was to remove a malignant tumor from my sigmoid. They told me to see my family doc. for the physical, blood draws and urine ck. I had already had 2 CT's with contrast to check my abdomen. I was told to scrub my lower body down twice with sanitizing soap they gave me, along with an Rx for a gallon of a PEG solution to drink. I checked in at 5 am and was in the O.R. at 7 am. Today, insurances go into convulsions if the patient spends even one extra night in hospital.

Same thing happened to me last year prior to my AAA repair and the removal of my malignant bladder tumor. Before the AAA repair, I checked in at 5:30 am, after scrubbing down twice with sanitizing soap at home. A tech. shaved my abdomen and on into surgery I went. Before my bladder tumor removal, I was told to be at the hospital by 3 PM (late day for the urologist). No shave, just NPO.

Since I have no internal rectal sphincters (from cancer surgery), I took 2 qts. of tap water at home the night before surgery. I WILL NOT SUBJECT ANY MEDICAL PERSONNEL TO MY ANUS leaking on an O.R. table. If I am going under general anesthesia, I always take a 2 qt. enema the night before. That is just a common courtesy to the medical people who will work on me and to give me some assurance that I won't make a mess on an O.R. table and mortify myself.