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 guideline, Choosing Wisely).
ECG
Within 1-3 months (ACC/AHA guideline)
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high-risk surgery (e.g., >3 hours, intraoperative blood loss >1000 cc, vascular, thoracic)
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cardiovascular disease
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CAD equivalents (DM, CVA/TIA, CHF, CKD, PAD)
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use of medications which alter cardiac conduction (e.g., amiodarone, quetiapine)
Hemoglobin/Hematocrit
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major total perioperative blood loss anticipated (>1000 cc)
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anemia or bleeding (history, symptoms or signs)
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condition associated with anemia (e.g., renal disease, cancer, liver disease)
BUN/Creatinine
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renal disease
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DM
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cardiovascular disease
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use of med which may impair renal function (e.g., ACE inhibitor)
Electrolytes
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renal disease
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use of med which may affect electrolytes (e.g., ACE inhibitor)
Glucose & Glycohemoglobin
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DM (known or suspected)
PT/INR
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bleeding history
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warfarin use
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liver disease
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malnutrition
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recent or long-term antibiotic use
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neurosurgery or cardiac surgery
PTT
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bleeding history
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neurosurgery or cardiac surgery
Platelet Count
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bleeding history
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myeloproliferative or -suppressive disease
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use of myelotoxic meds
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cirrhosis/portal hypertension
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neurosurgery or cardiac surgery
WBC
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infection
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myeloproliferative or -suppressive disease
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use of myelotoxic meds
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liver disease
UA
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urinary symptoms
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urologic procedure
Urine Pregnancy Test
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any surgery for a woman in whom pregnancy cannot be reliably excluded by history (e.g., hysterectomy, postmenopausal)
Chest Radiograph
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signs or symptoms of acute cardiopulmonary disease