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Category: Preoperative Evaluation

PREOPERATIVE EVALUATION

Patients who undergo plastic and reconstruction surgical procedures, just like any other type of invasive procedure from different fields of surgery, should undergo preoperative evaluation. In general, our basic guidelines within the standard of the American Board of Plastic Surgery are as follows: patients under the age of 40 should have at minimum a preoperative CBC which includes white blood count, hematocrit, hemoglobin, red blood cell count, as well as a coagulation panel, partial thrombin, and partial thromboplastin time (PT, PTT), in order to determine coagulation ability, that is the ability to COAG in the operating room in surgical dissection. Finally a beta hCG should be performed. This allows us to determine obviously if the patient is pregnant prior to surgery which would thereby indicate surgery under general anesthesia. Finally, an HIV is obtained in order to determine the status of HIV in case the operating room staff member should be stuck with a needle in the OR. Also, patients over the age of 40 will obtain 12-lead EKGs, especially if there is any history of hypertension or cardiac disease. A chest x-ray will also be performed on patients with a history of asthma or significant COPD or lung disease as determined by our preoperative internal medicine specialist.

Patients are cleared for surgery over the age of 45 by their primary care physician, especially if there is any history of cardiac, high blood pressure, diabetes, asthma or any form of rheumatoid arthritis or autoimmune disease. Specialists are absolutely required on patients with a history of diabetes, hypertension, cardiovascular disease, diabetes, history of cancer, history of autoimmune disease or any form of kidney disorder. Specialists can include cardiologists, nephrologists, as well as gynecologists, rheumatologists, autoimmune experts and infectious disease specialists in patients who have a history of MRSA or a history of infections, having undergone under surgical procedures in the past.

Mammograms are required for our patients 35 and over or with a family history of breast cancer or significant breast disease. Preoperative clearances by our Internal Medicine Specialists are absolutely essential on patients over the age of 40. All patients are required to have the expected laboratories, which should be evaluated before surgery in order to determine any abnormalities. Preparing new patients for surgery in advance will prevent problems in the operating room or postoperative complications.

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