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{{short description|Health care provided before a surgical operation}} |
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{{redirect|Pre-op|the state of a transgender person before surgery|Transsexual#Surgical status}} |
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'''Preoperative care''' refers to [[health care]] provided before a [[surgery|surgical operation]]. Preoperative care aims to do whatever is right to increase the success of the surgery. |
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At some point before the operation, the healthcare provider will assess the fitness of the person to have surgery. This assessment should include whatever tests are [[Indication (medicine)|indicated]], but not include [[Screening (medicine)|screening]] for conditions without an indication. |
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Immediately before surgery the person's body is prepared, perhaps by washing with an [[antiseptic]], and if needed, their anxiety is addressed to make them comfortable. |
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==Technique== |
==Technique== |
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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.<ref name="NicholsonColdwell2013">{{cite journal|last1=Nicholson|first1=Amanda|last2=Coldwell|first2=Chris H|last3=Lewis|first3=Sharon R|last4=Smith|first4=Andrew F|last5=Lewis|first5=Sharon R|title=Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia|year=2013|doi=10.1002/14651858.CD010160.pub2}}</ref> 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.<ref name="NicholsonColdwell2013"/> The available research does not give insight about any differences in outcomes depending on whether a doctor or nurse conducts this assessment.<ref name="NicholsonColdwell2013"/> |
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.<ref name="Ravindra">{{cite journal|last1=Ravindra|first1=P|last2=Fitzgerald|first2=J|title=Surgical preoperative assessment|year=2012|journal=Student BMJ|volume=344|pages=d7816|doi=10.1136/sbmj.d7816|s2cid=164318333|url=http://student.bmj.com/student/view-article.html?id=sbmj.d7816}}</ref><ref name="NicholsonColdwell2013">{{cite journal|last1=Nicholson|first1=Amanda|last2=Coldwell|first2=Chris H|last3=Lewis|first3=Sharon R|last4=Smith|first4=Andrew F|last5=Lewis|first5=Sharon R|title=Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia|year=2013|doi=10.1002/14651858.CD010160.pub2|pmid=24218062|journal=Reviews|issue=11|pages=CD010160|pmc=10981790}}</ref> 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.<ref name="NicholsonColdwell2013"/> The available research does not give insight about any differences in outcomes depending on whether a doctor or nurse conducts this assessment.<ref name="NicholsonColdwell2013"/> |
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===Addressing anxiety=== |
===Addressing anxiety=== |
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Playing calming music to patients immediately before surgery has a beneficial effect in addressing [[anxiety]] about the surgery.<ref name="BradtDileo2013">{{cite journal|last1=Bradt|first1=Joke|last2=Dileo|first2=Cheryl|last3=Shim|first3=Minjung|last4=Bradt|first4=Joke|title=Music interventions for preoperative anxiety|year=2013|doi=10.1002/14651858.CD006908.pub2}}</ref> |
Playing calming music to patients immediately before surgery has a beneficial effect in addressing [[anxiety]] about the surgery.<ref name="BradtDileo2013">{{cite journal|last1=Bradt|first1=Joke|last2=Dileo|first2=Cheryl|last3=Shim|first3=Minjung|last4=Bradt|first4=Joke|title=Music interventions for preoperative anxiety|year=2013|doi=10.1002/14651858.CD006908.pub2|pmid=23740695|journal=Reviews|volume=2013 |issue=6|pages=CD006908|pmc=9758540 }}</ref> |
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===Surgical site preparation=== |
===Surgical site preparation=== |
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[[Hair removal]] at the location where the surgical incision is made is often done before the surgery.<ref name="TannerNorrie2011">{{cite journal|last1=Tanner|first1=Judith|last2=Norrie|first2=Peter|last3=Melen|first3=Kate|last4=Tanner|first4=Judith|title=Preoperative hair removal to reduce surgical site infection|year=2011|doi=10.1002/14651858.CD004122.pub4}}</ref> Sufficient evidence does not exist to say that removing hair is a useful way to prevent infections.<ref name="TannerNorrie2011"/> When it is done immediately before surgery, the use of [[hair clippers]] might be preferable to [[shaving]].<ref name="TannerNorrie2011"/> |
[[Hair removal]] at the location where the surgical incision is made is often done before the surgery.<ref name="TannerNorrie2011">{{cite journal|last1=Tanner|first1=Judith|last2=Norrie|first2=Peter|last3=Melen|first3=Kate|last4=Tanner|first4=Judith|title=Preoperative hair removal to reduce surgical site infection|year=2011|doi=10.1002/14651858.CD004122.pub4|pmid=22071812|journal=Reviews|issue=11|page=CD004122}}</ref> Sufficient evidence does not exist to say that removing hair is a useful way to prevent infections.<ref name="TannerNorrie2011"/> When it is done immediately before surgery, the use of [[hair clippers]] might be preferable to [[shaving]].<ref name="TannerNorrie2011"/> |
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[[Bathing]] with an antiseptic like [[chlorhexidine]] does not seem to affect incidence of complications after surgery.<ref name="WebsterOsborne2012">{{cite journal|last1=Webster|first1=Joan|last2=Osborne|first2=Sonya|last3=Webster|first3=Joan|title=Preoperative bathing or showering with skin antiseptics to prevent surgical site infection|year=2012|doi=10.1002/14651858.CD004985.pub4}}</ref> However, washing the surgical site with chlorhexidine after surgery does seem helpful for preventing [[surgical site infection]].<ref name="DumvilleMcFarlane2013">{{cite journal|last1=Dumville|first1=Jo C|last2=McFarlane|first2=Emma|last3=Edwards|first3=Peggy|last4=Lipp|first4=Allyson|last5=Holmes|first5=Alexandra|last6=Dumville|first6=Jo C|title=Preoperative skin antiseptics for preventing surgical wound infections after clean surgery|year=2013|doi=10.1002/14651858.CD003949.pub3}}</ref> |
[[Bathing]] with an antiseptic like [[chlorhexidine]] does not seem to affect incidence of complications after surgery.<ref name="WebsterOsborne2012">{{cite journal|last1=Webster|first1=Joan|last2=Osborne|first2=Sonya|last3=Webster|first3=Joan|editor1-first=Joan|editor1-last=Webster|title=Preoperative bathing or showering with skin antiseptics to prevent surgical site infection|year=2012|doi=10.1002/14651858.CD004985.pub4|pmid=22972080|journal=Protocols|url=http://espace.library.uq.edu.au/view/UQ:283840/UQ283840_OA.pdf|issue=9|page=CD004985|hdl=10072/51996|hdl-access=free}}</ref> However, washing the surgical site with chlorhexidine after surgery does seem helpful for preventing [[surgical site infection]].<ref name="DumvilleMcFarlane2013">{{cite journal|last1=Dumville|first1=Jo C|last2=McFarlane|first2=Emma|last3=Edwards|first3=Peggy|last4=Lipp|first4=Allyson|last5=Holmes|first5=Alexandra|last6=Dumville|first6=Jo C|editor1-first=Jo C|editor1-last=Dumville|title=Preoperative skin antiseptics for preventing surgical wound infections after clean surgery|year=2013|doi=10.1002/14651858.CD003949.pub3|pmid=23543526|journal=Reviews|issue=3|pages=CD003949}}</ref> |
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==Risks== |
==Risks== |
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Commonly overused screenings include the following: |
Commonly overused screenings include the following: |
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*[[Electrocardiography|Electrocardiograms]] (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.<ref>{{Citation |author1 = American Academy of Ophthalmology |author1-link = American Academy of Ophthalmology |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American Academy of Ophthalmology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-ophthalmology/ |access-date = 6 January 2013}}</ref> |
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*[[Cardiac imaging]] and [[cardiac stress test]]s are usually unnecessary for people who do not have a serious heart condition and who are having surgery unrelated to the heart. |
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*[[Cardiac imaging]] and [[cardiac stress test]]s are usually unnecessary for people who do not have a serious heart condition and who are having surgery unrelated to the heart.<ref>{{Citation |author1 = American College of Cardiology |author1-link = American College of Cardiology |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American College of Cardiology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-cardiology/ |access-date = 10 February 2014}}</ref> People in the United States using government healthcare services are especially likely to have this procedure without indication.<ref name="SheffieldMcAdams2013">{{cite journal|last1=Sheffield|first1=Kristin M.|last2=McAdams|first2=Patricia S.|last3=Benarroch-Gampel|first3=Jaime|last4=Goodwin|first4=James S.|last5=Boyd|first5=Casey A.|last6=Zhang|first6=Dong|last7=Riall|first7=Taylor S.|title=Overuse of Preoperative Cardiac Stress Testing in Medicare Patients Undergoing Elective Noncardiac Surgery|journal=Annals of Surgery|volume=257|issue=1|year=2013|pages=73–80|issn=0003-4932|doi=10.1097/SLA.0b013e31826bc2f4|pmid=22964739|pmc=3521863}}</ref> |
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*[[Chest radiograph]]s are usually unnecessary for people under age 70, and not having chest surgery, and who do not have worrisome symptoms. |
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*[[Chest radiograph|Chest x-rays]] are usually unnecessary for people under age 70 who are not having chest surgery and who do not have worrisome symptoms.<ref>{{Citation |author1 = American College of Radiology |author1-link = American College of Radiology |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American College of Cardiology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/ |access-date = 3 September 2014}}</ref> |
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*Breathing tests are usually unnecessary for people who do not [[Smoking|smoke]], do not have [[Respiratory disease]], and who do not have symptoms |
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*Breathing tests are usually unnecessary for people who do not [[Smoking|smoke]], do not have [[respiratory disease]], and who do not have symptoms.<ref name="STSfive">{{Citation |author1 = Society of Thoracic Surgeons |author1-link = Society of Thoracic Surgeons |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = Society of Thoracic Surgeons |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/the-society-of-thoracic-surgeons/ |access-date = 18 December 2013}}</ref> |
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*[[Carotid ultrasonography]] is usually unnecessary for people who have not had a [[stroke]] or [[mini-stroke]].<ref name="STSfive"/> |
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==Special populations== |
==Special populations== |
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===Children=== |
===Children=== |
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Among children who are at |
Among children who are at normal risk of [[pulmonary aspiration]] or [[vomiting]] 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.<ref name="BradyKinn2009">{{cite journal|last1=Brady|first1=Marian C|last2=Kinn|first2=Sue|last3=Ness|first3=Valerie|last4=O'Rourke|first4=Keith|last5=Randhawa|first5=Navdeep|last6=Stuart|first6=Pauline|last7=Brady|first7=Marian C|title=Preoperative fasting for preventing perioperative complications in children|year=2009|doi=10.1002/14651858.CD005285.pub2|journal=Reviews|issue=4 |pages=CD005285 |pmid=19821343}}</ref> |
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===Recreational substance users=== |
===Recreational substance users=== |
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Sometimes before a surgery a health care provider will recommend some [[health intervention]] to modify some risky behavior which is associated with [[Complication (medicine)|complications]] from surgery. |
Sometimes before a surgery a health care provider will recommend some [[health intervention]] to modify some risky behavior which is associated with [[Complication (medicine)|complications]] from surgery. |
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[[Smoking cessation]] before surgery is likely to reduce the risk of complications from surgery.<ref name="ThomsenVillebro2014">{{cite journal|last1=Thomsen|first1=Thordis|last2=Villebro|first2=Nete|last3=Møller|first3=Ann Merete|last4=Thomsen|first4=Thordis|title=Interventions for preoperative smoking cessation|year=2014|doi=10.1002/14651858.CD002294.pub4}}</ref> |
[[Smoking cessation]] before surgery is likely to reduce the risk of complications from surgery.<ref name="ThomsenVillebro2014">{{cite journal|last1=Thomsen|first1=Thordis|last2=Villebro|first2=Nete|last3=Møller|first3=Ann Merete|last4=Thomsen|first4=Thordis|title=Interventions for preoperative smoking cessation|year=2014|doi=10.1002/14651858.CD002294.pub4|journal=Reviews|volume=2014 |pmid=24671929|issue=3|page=CD002294|pmc=7138216}}</ref> |
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| ⚫ | 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.<ref name="OppedalMøller2012">{{cite journal|last1=Oppedal|first1=Kristian|last2=Møller|first2=Ann Merete|last3=Pedersen|first3=Bolette|last4=Tønnesen|first4=Hanne|last5=Oppedal|first5=Kristian|title=Preoperative alcohol cessation prior to elective surgery|year=2012|doi=10.1002/14651858.CD008343.pub2|pmid=22786514|journal=Reviews|issue=7|pages=CD008343}}</ref> |
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== See also == |
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* [[Prehabilitation]] |
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| ⚫ | 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.<ref name="OppedalMøller2012">{{cite journal|last1=Oppedal|first1=Kristian|last2=Møller|first2=Ann Merete|last3=Pedersen|first3=Bolette|last4=Tønnesen|first4=Hanne|last5=Oppedal|first5=Kristian|title=Preoperative alcohol cessation prior to elective surgery|year=2012|doi=10.1002/14651858.CD008343.pub2}}</ref> |
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==References== |
==References== |
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*[http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html Preoperative care] in the ''Surgery Encyclopedia'' |
*[http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html Preoperative care] in the ''Surgery Encyclopedia'' |
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Latest revision as of 06:12, 8 April 2024
Preoperative care refers to health care provided before a surgical operation. Preoperative care aims to do whatever is right to increase the success of the surgery.
At some point before the operation, the healthcare provider will assess the fitness of the person to have surgery. This assessment should include whatever tests are indicated, but not include screening for conditions without an indication.
Immediately before surgery the person's body is prepared, perhaps by washing with an antiseptic, and if needed, their anxiety is addressed to make them comfortable.
Technique
[edit]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.[1][2] 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.[2] The available research does not give insight about any differences in outcomes depending on whether a doctor or nurse conducts this assessment.[2]
Addressing anxiety
[edit]Playing calming music to patients immediately before surgery has a beneficial effect in addressing anxiety about the surgery.[3]
Surgical site preparation
[edit]Hair removal at the location where the surgical incision is made is often done before the surgery.[4] Sufficient evidence does not exist to say that removing hair is a useful way to prevent infections.[4] When it is done immediately before surgery, the use of hair clippers might be preferable to shaving.[4]
Bathing with an antiseptic like chlorhexidine does not seem to affect incidence of complications after surgery.[5] However, washing the surgical site with chlorhexidine after surgery does seem helpful for preventing surgical site infection.[6]
Risks
[edit]Screening is a test to see whether a person has a disease, and screenings are often done before surgery. Screenings should happen when they are indicated and not otherwise as a matter of routine. Screenings which are done without indication carry the risks of having unnecessary health care.
Commonly overused screenings include the following:
- Electrocardiograms (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.[7]
- Cardiac imaging and cardiac stress tests are usually unnecessary for people who do not have a serious heart condition and who are having surgery unrelated to the heart.[8] People in the United States using government healthcare services are especially likely to have this procedure without indication.[9]
- Chest x-rays are usually unnecessary for people under age 70 who are not having chest surgery and who do not have worrisome symptoms.[10]
- Breathing tests are usually unnecessary for people who do not smoke, do not have respiratory disease, and who do not have symptoms.[11]
- Carotid ultrasonography is usually unnecessary for people who have not had a stroke or mini-stroke.[11]
Special populations
[edit]Children
[edit]Among children who are at normal risk of pulmonary aspiration or vomiting 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.[12]
Recreational substance users
[edit]Sometimes before a surgery a health care provider will recommend some health intervention to modify some risky behavior which is associated with complications from surgery.
Smoking cessation before surgery is likely to reduce the risk of complications from surgery.[13]
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.[14]
See also
[edit]References
[edit]- ^ Ravindra, P; Fitzgerald, J (2012). "Surgical preoperative assessment". Student BMJ. 344: d7816. doi:10.1136/sbmj.d7816. S2CID 164318333.
- ^ a b c Nicholson, Amanda; Coldwell, Chris H; Lewis, Sharon R; Smith, Andrew F; Lewis, Sharon R (2013). "Nurse-led versus doctor-led preoperative assessment for elective surgical patients requiring regional or general anaesthesia". Reviews (11): CD010160. doi:10.1002/14651858.CD010160.pub2. PMC 10981790. PMID 24218062.
- ^ Bradt, Joke; Dileo, Cheryl; Shim, Minjung; Bradt, Joke (2013). "Music interventions for preoperative anxiety". Reviews. 2013 (6): CD006908. doi:10.1002/14651858.CD006908.pub2. PMC 9758540. PMID 23740695.
- ^ a b c Tanner, Judith; Norrie, Peter; Melen, Kate; Tanner, Judith (2011). "Preoperative hair removal to reduce surgical site infection". Reviews (11): CD004122. doi:10.1002/14651858.CD004122.pub4. PMID 22071812.
- ^ Webster, Joan; Osborne, Sonya; Webster, Joan (2012). Webster, Joan (ed.). "Preoperative bathing or showering with skin antiseptics to prevent surgical site infection" (PDF). Protocols (9): CD004985. doi:10.1002/14651858.CD004985.pub4. hdl:10072/51996. PMID 22972080.
- ^ Dumville, Jo C; McFarlane, Emma; Edwards, Peggy; Lipp, Allyson; Holmes, Alexandra; Dumville, Jo C (2013). Dumville, Jo C (ed.). "Preoperative skin antiseptics for preventing surgical wound infections after clean surgery". Reviews (3): CD003949. doi:10.1002/14651858.CD003949.pub3. PMID 23543526.
- ^ American Academy of Ophthalmology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Ophthalmology, retrieved 6 January 2013
- ^ American College of Cardiology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Cardiology, retrieved 10 February 2014
- ^ Sheffield, Kristin M.; McAdams, Patricia S.; Benarroch-Gampel, Jaime; Goodwin, James S.; Boyd, Casey A.; Zhang, Dong; Riall, Taylor S. (2013). "Overuse of Preoperative Cardiac Stress Testing in Medicare Patients Undergoing Elective Noncardiac Surgery". Annals of Surgery. 257 (1): 73–80. doi:10.1097/SLA.0b013e31826bc2f4. ISSN 0003-4932. PMC 3521863. PMID 22964739.
- ^ American College of Radiology (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Cardiology, retrieved 3 September 2014
- ^ a b Society of Thoracic Surgeons (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, Society of Thoracic Surgeons, retrieved 18 December 2013
- ^ Brady, Marian C; Kinn, Sue; Ness, Valerie; O'Rourke, Keith; Randhawa, Navdeep; Stuart, Pauline; Brady, Marian C (2009). "Preoperative fasting for preventing perioperative complications in children". Reviews (4): CD005285. doi:10.1002/14651858.CD005285.pub2. PMID 19821343.
- ^ Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete; Thomsen, Thordis (2014). "Interventions for preoperative smoking cessation". Reviews. 2014 (3): CD002294. doi:10.1002/14651858.CD002294.pub4. PMC 7138216. PMID 24671929.
- ^ Oppedal, Kristian; Møller, Ann Merete; Pedersen, Bolette; Tønnesen, Hanne; Oppedal, Kristian (2012). "Preoperative alcohol cessation prior to elective surgery". Reviews (7): CD008343. doi:10.1002/14651858.CD008343.pub2. PMID 22786514.
External links
[edit]- Preoperative care in the Surgery Encyclopedia