Guidelines for Appropriate Preoperative Investigations of Patients for Elective Surgery

Traditionally, all patients scheduled for elective surgery undergo routine evaluation as part of the assessment of fitness for anaesthesia and surgery. In many cases, a large battery of tests is done even in patients who have no history of medical illness and are clinically normal. In the past years, physicians have questioned the usefulness and cost-benefit of performing such routine screening tests in presumably healthy patients. Many have recognized that these tests usually do not detect diseases in persons with no symptoms and a normal physical examination, and hence have little or no impact on the anaesthetic and surgical management or outcome. The current recommendation by developed countries in North America and Europe is that selective (indicated or diagnostic) tests, guided by the patient's health condition, invasiveness of planned surgery and potential for blood loss, is the best method of preoperative assessment and preparation for surgery. Performing routine tests for all surgical patients as a screening tool has been found to be inefficient and not cost-effective. A change from routine to indicated testing has been shown to result in considerable cost-savings to patients and hospitals. Jamaica is a country with limited resources. Therefore, we hope to highlight and implement appropriate preoperative evaluation for surgical patients, and hence to achieve considerable cost-savings to the healthcare system".