Preoperative care refers to

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

provided before a

surgical operation Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

. 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 In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis ...

, but not include

screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a ...

for conditions without an indication. Immediately before surgery the person's body is prepared, perhaps by washing with an

antiseptic An antiseptic (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") is an antimicrobial substance or compound that is applied to living tissue/skin to reduce the possibility of infection, sepsis, or putre ...

, 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. 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. The available research does not give insight about any differences in outcomes depending on whether a doctor or nurse conducts this assessment.

Addressing anxiety

Playing calming music to patients immediately before surgery has a beneficial effect in addressing

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...

about the surgery.

Surgical site preparation

Hair removal Hair removal, also known as epilation or depilation, is the deliberate removal of body hair or head hair. Hair typically grows all over the human body and can vary in thickness and length across human populations. Hair can become more visible ...

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

shaving Shaving is the removal of hair, by using a razor or any other kind of bladed implement, to slice it down—to the level of the skin or otherwise. Shaving is most commonly practiced by men to remove their facial hair and by women to remove the ...

Bathing Bathing is the act of washing the body, usually with water, or the immersion of the body in water. It may be practiced for personal hygiene, religious ritual or therapeutic purposes. By analogy, especially as a recreational activity, the term is ...

with an antiseptic like

chlorhexidine Chlorhexidine (CHX) (commonly known by the salt forms chlorhexidine gluconate and chlorhexidine digluconate (CHG) or chlorhexidine acetate) is a disinfectant and antiseptic that is used for skin disinfection before surgery and to sterilize surg ...

does not seem to affect incidence of complications after surgery. However, washing the surgical site with chlorhexidine after surgery does seem helpful for preventing surgical site infection.

Risks

Screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a ...

is a test to see whether a person has a

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

, and screenings are often done before surgery. Screenings should happen when they are

and not otherwise as a matter of routine. Screenings which are done without indication carry the risks of having

unnecessary health care Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overuse was the ...

. Commonly overused screenings include the following: *

Electrocardiograms Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...

(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. *

Cardiac imaging Cardiac imaging refers to non-invasive imaging of the heart using ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or nuclear medicine (NM) imaging with PET or SPECT. These cardiac techniques are otherwise referred to as ec ...

and

cardiac stress test A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures the heart's ability to respond to external stress in a controlled clinical environ ...

s are usually unnecessary for people who do not have a serious heart condition and who are having surgery unrelated to the heart. People in the United States using government healthcare services are especially likely to have this procedure without indication. *

Chest x-rays A chest radiograph, called a chest X-ray (CXR), or chest film, is a Projectional radiography, projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most ...

are usually unnecessary for people under age 70 who are not having chest surgery and who do not have worrisome symptoms. *Breathing tests are usually unnecessary for people who do not

smoke Smoke is a suspension of airborne particulates and gases emitted when a material undergoes combustion or pyrolysis, together with the quantity of air that is entrained or otherwise mixed into the mass. It is commonly an unwanted by-product ...

, do not have

respiratory disease Respiratory diseases, or lung diseases, are pathology, pathological conditions affecting the organs and tissues that make gas exchange difficult in Breathing, air-breathing animals. They include conditions of the respiratory tract including the t ...

, and who do not have symptoms. *

Carotid ultrasonography Carotid ultrasonography is an ultrasound-based diagnostic imaging technique to evaluate structural details of the carotid arteries. Carotid ultrasound is used to diagnose carotid artery stenosis (CAS) and can assess atherosclerotic plaque morpholo ...

is usually unnecessary for people who have not had a

stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...

or mini-stroke.

Special populations

Children

Among children who are at normal risk of

pulmonary aspiration Pulmonary aspiration is the entry of material such as pharyngeal secretions, food or drink, or stomach contents from the oropharynx or gastrointestinal tract, into the larynx (voice box) and lower respiratory tract, the portions of the respira ...

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

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.

Recreational substance users

Sometimes before a surgery a health care provider will recommend some

health intervention A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and n ...

to modify some risky behavior which is associated with complications from surgery.

Smoking cessation Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...

before surgery is likely to reduce the risk of complications from surgery. 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.

References

{{reflist

External links

Preoperative care
in the ''Surgery Encyclopedia'' Surgery