The Philippine College of Surgeons evidence-based clinical practice guidelines on preoperative evaluation of ASA I and II adult patients undergoing elective non-cardiac surgery

ABSTRACT

@#It is the practice in most health care institutions in our country to have patients for elective surgery evaluated pre-operatively by Internists and Anesthesiologists. Practitioners don’t seem to agree on how this is to be carried out. Each institution has its own protocol and even individual physicians have their own preference, which they have learned either during their training or from experience. Physicians usually request for preoperative tests for patients undergoing elective surgery in order to minimize risk, and to serve as a baseline to detect subsequent changes. Several authors agree to this as the goal of pre-operative evaluation. This is being done to identify risk factors and to screen broadly for undiagnosed disease. Undiagnosed clinical conditions are correlated with the risk of complications during the perioperative period. This then allows the physician to identify patients with increased risk of morbidity and mortality, and to help them design preoperative strategies that can reduce these risks. These tests can be helpful to stratify risk and guide postoperative management; however, most of them are obtained because of protocol rather than medical necessity. Majority of surgeries performed are non-cardiac in nature. Mortality rates for these procedures can be as high as 4% depending on the patient’s risk and type of surgery. Cardiovascular complications account for half of all morbidities and mortalities in the perioperative period for patients undergoing non-cardiac surgery.