Pre-operative outpatient medical evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries. To effectively provide this consultative service, the physician should understand the risk associated with the particular type of surgery planned and relate this risk to the patient's underlying acute and chronic medical problems. The complete consultation should include recommendations for evaluation and treatment, including prophylactic therapies to minimize the perioperative risk.
The complete preoperative evaluation includes the following sections:
- Medical History
- Physical Examination
- Chief Complain
- Performance Status
- Karnofsky score (80 to 100 percent)
- Zubrod (Eastern Cooperative Oncology Group [ECOG] ) system (0-1)
- Functional Status
- 6-min walk
- Stair climbing
- Shuttle walk
- Initial Evalution
- Vital Signs
- Somatometrics
- Examination by System
- Consideration
- Differential Diagnosis
- Imaging & Dynamic Exams
- Blood Tests
- Respiratory mechanics
- FEV1
- FVC
- ppo- FEV1 = FEV1 x (1 - [number of resected segments/19]/100)
- ppo: Predicted PostOperative
- patients with ppo- FEV1 > 40%, are low risk
- Parenchymal function
- Diffusing capacity for carbon monoxide [DLco]
- ppo-DLco = DLco x (1 - [number of resected segments/19]/100)
- patients with ppo-DLco > 40%, are low risk
- Diffusing capacity for carbon monoxide [DLco]
- Cardiopulmonary interaction
- CPEx VO2max
- < 10 mL/kg/min : high risk
- 10 to 15 mL/kg/min : intermidiate risk
- 15 to 20 mL/kg/min : low isk
- indication for patients with: ppo- FEV1 < 40% ppo-DLco < 40% ppo- FEV1 Χ ppo-DLco < 1650
- CPEx VO2max
- Transthoracic echocardiogram
- Ventilation Perfusion Lung Scintigraphy
- Vibration Response Imaging, VRIxp™
- Chest Echo
- Chest CT
- Brain MRI
- PET-CT
- Bronchoscopy
- Gastroscopy
- Colonoscopy
- Assessments
- Gynecological Assessment
- Cardiological Assessment
- Anesthetic Assessment
- Endocrine Assessment
- Neurological Assessment
- Thoracoscore
