Standard Blood Work Tests for Pre-Surgical Evaluation

The comprehensive pre-surgical evaluation is crucial to ensuring the safety and success of a surgical procedure. This process involves a series of blood work tests that help the surgical team understand the patient's overall health condition. Understanding the two main categories of these tests—those ordered by the surgeon and those by the anesthesiologist—can significantly enhance the patient's experience and outcomes.

Tests Ordered by the Surgeon

Surgeons typically order blood work tests that are related to the specific surgical procedure and potential post-operative complications. These can be broadly categorized into tests related to the diagnosis and symptoms of the condition being treated, as well as tests aimed at preventing specific post-operative complications.

Tests Related to Diagnosis and Symptoms

Coagulation Factors: If post-operative anticoagulation is necessary for deep vein thrombosis prevention. Blood Cross-Match: To prepare for potential surgical blood loss. Gastrointestinal Enzymes and Liver Pancreas Panels: For patients with symptoms or conditions related to these organs. CBC (Complete Blood Count): To check for infections, anemia, or other hematological issues, especially if a patient has a fever. Serum Calcium: For surgeries involving the parathyroid or thyroid glands.

Tests Ordered by the Anesthesiologist

The anesthesiologist, on the other hand, orders a range of tests to evaluate the patient's general health status and any pre-existing conditions. These tests are further divided into two categories: specific pre-existing conditions and routine screening tests.

Specific Pre-Existing Conditions

For patients with known pre-existing conditions, the anesthesiologist may order additional tests to ensure that these conditions are stable and to understand their severity. These tests are usually ordered based on the patient's medical history and the medications they are taking.

Hemoglobin A1C: To assess long-term blood glucose control for diabetes patients. Coagulation Factors: To check for any risk of bleeding or clotting disorders. CARDIAC STRESS TEST: To evaluate heart function and assess the risk of cardiovascular disease. To check the function of the kidneys and identify any pre-existing kidney disease. Pulmonary Function Tests: To assess lung function, often using bedside spirometry.

Routine Screening Tests

The anesthesiologist also orders routine screening tests to identify any non-pre-existing conditions that pose an elevated risk due to factors such as age, weight, or anticipated surgical complications. These tests strike a balance between being thorough and avoiding excessive costs.

Routine Blood Tests: Such as CBC, electrolytes, and liver function tests to screen for any hidden health issues. Urine Tests: To check for signs of kidney issues or other urinary tract infections. Cardiovascular Risk Assessments: Including echocardiograms or cholesterol screenings for patients with a higher risk of cardiovascular disease.

Guidelines and Recommendations

Both the American Society of Anesthesiologists (ASA) and the Canadian Anesthetists Society provide well-documented guidelines that anesthesiologists can refer to for pre-operative screening. These guidelines help maintain a balance between the thoroughness of the tests and the cost implications to the patient and healthcare system.

Sub-specialty guidelines from organizations such as the Canadian Cardiovascular Society further augment these general guidelines, providing more specific recommendations for certain medical conditions and surgical specialties.

The comprehensive pre-operative evaluation, involving both surgeon-ordered and anesthesiologist-ordered tests, plays a vital role in ensuring that the patient is as healthy and prepared as possible for the surgical procedure. It helps the healthcare team anticipate and address any potential issues, leading to improved outcomes and a safer surgery for the patient.