What is a preoperative clearance?
The preoperative clearance helps the doctors to decide if the patient is suitable for the proposed surgery according to the patient's risk category, also it helps them to identify the factors that may reduce the patient's risk for complications and provide the best possible recommendations for the post-operative care.
Preoperative clearance usually starts by identifying the type of surgery to be performed and the risk category of the patient who needs this surgery. To make an appointment, call the office or book online today.
What factors influence the risk of perioperative complications?
Patients can be divided into different risk categories based on the basis of their preoperative medical assessment. This helps the doctors to decide if the patient is suitable for the proposed surgery or procedure, and identify the factors that may reduce the patient’s risk. There are many factors that may influence the risk of perioperative complications, including death.
Anesthesia
Although modern anesthesia is safe, the risk of surgical complications varies according to the type of anesthesia (general or regional). The patient's factors and surgical factors are more important risk predictors for post-operative complications.
The American society of anesthesiologists (ASA) classification is a predictor of perioperative mortality. It also predicts cardiac and pulmonary morbidity.
ASA classification
Class | Systemic disturbance | Mortality rate |
1 | Healthy patient with no disease outside of the surgical process | <0.03% |
2 | Mild-to-moderate systemic disease caused by the surgical condition or by other pathologic processes | 0.2% |
3 | Severe disease process which limits activity but is not incapacitating | 1.2% |
4 | Severe incapacitating disease process that is a constant threat to life | 8% |
5 | Moribund patient not expected to survive 24 hours with or without an operation | 34% |
E | Suffix to indicate an emergency surgery for any class | Increased |
Type of surgery
Perioperative risk of complications varies according to the type of surgery.
Patient age
Some studies showed that the risk of surgery increases with advancing age.[1] [2]
Emergency procedures
In emergency procedures, the risk of complications may increase two to four times, or even more than that in elderly patients.
Pulmonary factors
There are several pulmonary factors that may increase the risk of complications in surgical patients, these may include:
- Cigarette smoking.[3]
- Respiratory diseases.
- Abnormal chest x-ray or physical examination findings.
- Thoracic or upper abdominal surgery.
- Morbid obesity.
- Age over 60.
Cardiac factors
There are several cardiac factors that may increase the risk of complications in surgical patients, these may include:
- History of prosthetic valves.
- History of rheumatic fever.
- Congestive heart failure.
- Arrhythmia
