General Medical Assessment

Before surgery, the surgeon should obtain a general medical history from the patient or, if necessary, from caregivers. A complete and accurate drug history is especially important. The elderly often use several drugs concurrently, sometimes leading to adverse drug interactions or interactions with comorbidities that may cause problems perioperatively. At least half of chronically ill patients make errors when they report their drug use; many of these errors are potentially serious. Thus, the primary care physician, caregivers, or both should be asked to confirm drug use; for patients staying at a long-term care facility, an up-to-date drug record should be obtained from the facility.

A complete physical examination should be done. Examining the skin, oral mucosa, and tongue can provide information about hydration and nutrition. Femoral, popliteal, pedal, brachial, and radial pulses should be noted, and patients should be checked for evidence of venous disorders (eg, varicose veins, postphlebitic ulcers, edema). Evaluation of cognitive status and cardiac, pulmonary, and neurologic examinations help in assessment of surgical risk. Results should be recorded in case a baseline is needed for comparison later. Routine laboratory testing includes urinalysis; CBC; renal and liver function tests; measurement of glucose, electrolytes, and coagulation factors; and ECG. Although a chest x-ray is usually taken, its usefulness has not been established.

A few disorders that are common among the elderly (eg, hypothyroidism, diabetes, dementia) are often undiagnosed at the time of surgery.

This topic was last updated March 2006.