© 2018 Kurt Pfeifer.

BASIC DIAGNOSTIC TESTING

The following recommendations are based on the ASA practice advisory regarding diagnostic testing, Choosing Wisely recommendations, ACC/AHA guideline, and recent narrative reviews. Italicized recommendations are the author's personal opinion. Labs should be obtained within 2-4 months (Ruetzler et al, Macpherson et al) or 6 months (ASA practice advisory), or earlier if there has been a significant change in the patient’s condition. This list is intended to provide recommendations for the majority of non-low risk surgeries. For low-risk surgeries (eg, cataract surgery or hernia repair), no screening labs, ECG, or CXR are indicated in asymptomatic individuals (ACC/AHA guidelineChoosing Wisely).

ECG

Within 1-3 months (ACC/AHA guideline)

  • high-risk surgery (e.g., >3 hours, intraoperative blood loss >1000 cc, vascular, thoracic)

  • cardiovascular disease

  • CAD equivalents (DM, CVA/TIA, CHF, CKD, PAD)

  • use of medications which alter cardiac conduction (e.g., amiodarone, quetiapine)

Hemoglobin/Hematocrit

  • major total perioperative blood loss anticipated (>1000 cc)

  • anemia or bleeding (history, symptoms or signs)

  • condition associated with anemia (e.g., renal disease, cancer, liver disease)

BUN/Creatinine

  • renal disease

  • DM

  • cardiovascular disease

  • use of med which may impair renal function (e.g., ACE inhibitor)

Electrolytes

  • renal disease

  • use of med which may affect electrolytes (e.g., ACE inhibitor)

Glucose & Glycohemoglobin

  • DM (known or suspected)

PT/INR

  • bleeding history

  • warfarin use

  • liver disease

  • malnutrition

  • recent or long-term antibiotic use

  • neurosurgery or cardiac surgery

PTT

  • bleeding history

  • neurosurgery or cardiac surgery

Platelet Count

  • bleeding history

  • myeloproliferative or -suppressive disease

  • use of myelotoxic meds

  • cirrhosis/portal hypertension

  • neurosurgery or cardiac surgery

WBC

  • infection

  • myeloproliferative or -suppressive disease

  • use of myelotoxic meds

  • liver disease

UA

  • urinary symptoms

  • urologic procedure

Urine Pregnancy Test

  • any surgery for a woman in whom pregnancy cannot be reliably excluded by history (e.g., hysterectomy, postmenopausal)

Chest Radiograph

  • signs or symptoms of acute cardiopulmonary disease