Preoperative care

Preoperative care refers to health care provided before a surgical operation. The aim of preoperative care is to do whatever is right to increase the success of the surgery.

At some point before the operation the health care provider will assess the fitness of the person to have surgery. This assessment should include whatever tests are indicated, but not include screening for conditions without an indication.

Immediately before surgery the person's body is prepared, perhaps by washing with an antiseptic, and whenever possible their anxiety is addressed to make them comfortable.

Technique

At some point before surgery a health care provider conducts a preoperative assessment to verify that a person is fit and ready for the surgery.[1][2] For surgeries in which a person receives either general or local anesthesia, this assessment may be done either by a doctor or a nurse trained to do the assessment.[2] The available research does not give insight about any differences in outcomes depending on whether a doctor or nurse conducts this assessment.[2]

Addressing anxiety

Playing calming music to patients immediately before surgery has a beneficial effect in addressing anxiety about the surgery.[3]

Surgical site preparation

Hair removal at the location where the surgical incision is made is often done before the surgery.[4] Sufficient evidence does not exist to say that removing hair is a useful way to prevent infections.[4] When it is done immediately before surgery, the use of hair clippers might be preferable to shaving.[4]

Bathing with an antiseptic like chlorhexidine does not seem to affect incidence of complications after surgery.[5] However, washing the surgical site with chlorhexidine after surgery does seem helpful for preventing surgical site infection.[6]

Risks

Screening is a test to see whether a person has a disease, and screenings are often done before surgery. Screenings should happen when they are indicated and not otherwise as a matter of routine. Screenings which are done without indication carry the risks of having unnecessary health care.

Commonly overused screenings include the following:

  • Electrocardiograms (ECGs) are sometimes given before any kind of surgery as a matter of routine, but are unnecessary if a person does not have new and worrisome symptoms and if the surgery is minor. Eye surgery, for example, would not usually require an ECG.[7]
  • Cardiac imaging and cardiac stress tests are usually unnecessary for people who do not have a serious heart condition and who are having surgery unrelated to the heart.[8] People in the United States using government healthcare services are especially likely to have this procedure without indication.[9]
  • Chest x-rays are usually unnecessary for people under age 70 who are not having chest surgery and who do not have worrisome symptoms.[10]
  • Breathing tests are usually unnecessary for people who do not smoke, do not have respiratory disease, and who do not have symptoms.[11]
  • Carotid ultrasonography is usually unnecessary for people who have not had a stroke or mini-stroke.[11]

Special populations

Children

Among children who are at normal risk for normal risk of pulmonary aspiration or vomiting during anaesthesia, there is no evidence showing that denying them oral liquids before surgery improves outcomes but there is evidence showing that giving liquids prevents anxiety.[12]

Recreational substance users

Sometimes before a surgery a health care provider will recommend some health intervention to modify some risky behavior which is associated with complications from surgery.

Smoking cessation before surgery is likely to reduce the risk of complications from surgery.[13]

In circumstances in which a person's doctor advises them to avoid drinking alcohol before and after the surgery, but in which the person seems likely to drink anyway, intense interventions which direct a person to quit using alcohol have been proven to be helpful in reducing complications from surgery.[14]

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References
  1. Ravindra, P; Fitzgerald, J (2012). "Surgical preoperative assessment". Student BMJ.
  2. Nicholson, Amanda; Coldwell, Chris H; Lewis, Sharon R; Smith, Andrew F; Lewis, Sharon R (2013). "Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia". Reviews (11): CD010160. doi:10.1002/14651858.CD010160.pub2. PMID 24218062.
  3. Bradt, Joke; Dileo, Cheryl; Shim, Minjung; Bradt, Joke (2013). "Music interventions for preoperative anxiety". Reviews (6): CD006908. doi:10.1002/14651858.CD006908.pub2. PMID 23740695.
  4. Tanner, Judith; Norrie, Peter; Melen, Kate; Tanner, Judith (2011). "Preoperative hair removal to reduce surgical site infection". Reviews (11): CD004122. doi:10.1002/14651858.CD004122.pub4. PMID 22071812.
  5. Webster, Joan; Osborne, Sonya; Webster, Joan (2012). "Preoperative bathing or showering with skin antiseptics to prevent surgical site infection" (PDF). Protocols (9): CD004985. doi:10.1002/14651858.CD004985.pub4. PMID 22972080.
  6. Dumville, Jo C; McFarlane, Emma; Edwards, Peggy; Lipp, Allyson; Holmes, Alexandra; Dumville, Jo C (2013). "Preoperative skin antiseptics for preventing surgical wound infections after clean surgery". Reviews (3): CD003949. doi:10.1002/14651858.CD003949.pub3. PMID 23543526.
  7. American Academy of Ophthalmology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Ophthalmology, retrieved 6 January 2013
  8. American College of Cardiology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Cardiology, retrieved 10 February 2014
  9. Sheffield, Kristin M.; McAdams, Patricia S.; Benarroch-Gampel, Jaime; Goodwin, James S.; Boyd, Casey A.; Zhang, Dong; Riall, Taylor S. (2013). "Overuse of Preoperative Cardiac Stress Testing in Medicare Patients Undergoing Elective Noncardiac Surgery". Annals of Surgery. 257 (1): 73–80. doi:10.1097/SLA.0b013e31826bc2f4. ISSN 0003-4932. PMC 3521863. PMID 22964739.
  10. American College of Radiology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Cardiology, retrieved 3 September 2014
  11. Society of Thoracic Surgeons (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, Society of Thoracic Surgeons, retrieved 18 December 2013
  12. Brady, Marian C; Kinn, Sue; Ness, Valerie; O'Rourke, Keith; Randhawa, Navdeep; Stuart, Pauline; Brady, Marian C (2009). "Preoperative fasting for preventing perioperative complications in children". Reviews. doi:10.1002/14651858.CD005285.pub2.
  13. Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete; Thomsen, Thordis (2014). "Interventions for preoperative smoking cessation". Reviews (3): CD002294. doi:10.1002/14651858.CD002294.pub4. PMC 7138216. PMID 24671929.
  14. Oppedal, Kristian; Møller, Ann Merete; Pedersen, Bolette; Tønnesen, Hanne; Oppedal, Kristian (2012). "Preoperative alcohol cessation prior to elective surgery". Reviews (7): CD008343. doi:10.1002/14651858.CD008343.pub2. PMID 22786514.
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