1. Carefully consider the patient's age, surgical procedure, and type of anesthesia in deciding testing. Contact the Preoperative Anesthesiology Assessment Clinic for assistance. Other testing may be indicated for patients with positive history or physical findings. (See "Specific Conditions")

2. Please include detailed or actual results of tests: a report of "OK" is not helpful, and a Chest X-ray or Electrocardiogram report of "No change" is not helpful without access to the previous report. Lab results from any accredited facility will be accepted. Blood tests should not be more than six weeks old. A CXR or ECG may be up to six months old, depending on the stability of the patient's medical condition.

3.Possible Pregnancy Risk: Any female (between menarche and menopause) should be offered a pregnancy test (preferably on the day of surgery) before exposure to multiple drugs or intraoperative X-rays. The questions that should be posed are: "Could you possibly be pregnant?" & "Do you want a pregnancy test?" These questions may usually be omitted in patients who have had surgical sterilization/hysterectomy. Patients undergoing a pelvic or intra-abdominal procedure should receive a pregnancy test unless the surgeon, anesthesiologist, and patient agree that testing is not needed. Patients should always be informed whenever a pregnancy test is performed. See "Pregnancy Guideline" .

4. "Minor Procedures" are those with very low risk of large fluid shifts or significant blood loss. Soft tissue & Eye procedures, minor Ortho, ENT, and Urologic procedures, among others. Keep in mind that a "minor" procedure may turn into a "moderately complex" procedure. The surgeon's past experience with each particular procedure should be taken into account.
***Cataract procedures done without general anesthesia need little, if any, specific testing. However, if there are tests indicated on the basis of the preoperative exam, these should be performed (i.e. suspicious symptoms of chest pain indicate the need, for example, for an ECG.)

5. May waive for some patients who are asymptomatic and active patients who can give a reliable history or who are having procedures performed without general anesthesia. Preoperative Anesthesiology Assessment Clinic welcomes consultation about indicated tests with surgeons or primary physicians, especially prior to the day of elective surgery.

6. CMS (and many private payer's) do not reimburse for "routine" preoperative ECGs. According to Wisconsin's local CMS carrier, ECGs may be reimbursed for asymptomatic patients if the patient meets age criteria (males age > 40, females > 50) and surgery is "major." Note that some of our "moderate" procedures fit Medicare's definition of "major" (intraperitoneal, peripheral vascular, head and neck, etc.).

7. Glucose may be via fasting "AccuCheck" method.

8. A CXR is often indicated before many major abdominal or cardiothoracic procedures, especially if the patient is older. It may be indicated if the patient is < age 60 for some "moderate" intensity procedures.
CMS does not reimburse for "routine" preoperative CXRs. According to Wisconsin's local CMS carrier, the medical record (and the CXR request) must document an acute symptom in the review of systems or an exam finding which shows medical necessity in order for the test to be reimbursed. When a preexisting pulmonary condition is present, an acute problem must also be present for reimbursement. However, just because CMS won't pay doesn't mean that a CXR may not be medically indicated. It is important to consider what, if any, pathology is suspected or how the results of the CXR report could change the perioperative management.

9. Type & Screen /Type & Cross-Match must be performed only at UW Hospital for surgeries being performed at UWHC.

10. "Major Procedures" are those which are often prolonged, often with high risk of large fluid shifts or significant blood loss. They often involve major body cavities. These include major Abdominal, Vascular, Cardiothoracic, Ortho, Gynecologic/Urologic, Head and Neck, and Neuro procedures, among others.

11. PT & APTT tests are indicated when anticoagulation is expected; e.g. cardiovascular procedures. Otherwise, not usually indicated except with a history of suspected familial or acquired coagulation defects.

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