Editing Surgery (section)

=== Preoperative care ===
{{main|Preoperative care}}
Prior to surgery, the person is given a [[medical examination]], receives certain pre-operative tests, and their [[physical fitness|physical status]] is rated according to the [[ASA physical status classification system]]. If these results are satisfactory, the person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an [[autologous]] [[blood donation]] may be made some weeks prior to surgery. If the surgery involves the [[digestive system]], the person requiring surgery may be instructed to perform a [[Whole bowel irrigation|bowel prep]] by drinking a solution of [[polyethylene glycol]] the night before the procedure. People preparing for surgery are also instructed to abstain from food or drink (an [[Nil per os|NPO order]] after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the person vomits during or after the procedure.<ref name=":1" />

Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.<ref name="ACRfive">{{Cite journal |author1 = American College of Radiology |author1-link = American College of Radiology |title = Five Things Physicians and Patients Should Question |journal = Choosing Wisely: An Initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/ |access-date = 17 August 2012 |url-status=live |archive-url = https://web.archive.org/web/20130210080213/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/ |archive-date = 10 February 2013 }}, citing
* {{cite web|title=American College of Radiology ACR Appropriateness Criteria|url=http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/|publisher=American College of Radiology|access-date=4 September 2012|year=2000|url-status=live|archive-url=https://web.archive.org/web/20130210080213/http://www.choosingwisely.org/doctor-patient-lists/american-college-of-radiology/|archive-date=10 February 2013|df=dmy-all}} Last reviewed 2011.
* {{cite journal | vauthors = Gómez-Gil E, Trilla A, Corbella B, Fernández-Egea E, Luburich P, de Pablo J, Ferrer Raldúa J, Valdés M | title = Lack of clinical relevance of routine chest radiography in acute psychiatric admissions | journal = General Hospital Psychiatry | volume = 24 | issue = 2 | pages = 110–113 | year = 2002 | pmid = 11869746 | doi = 10.1016/s0163-8343(01)00179-7 }}
* {{cite journal | vauthors = Archer C, Levy AR, McGregor M | title = Value of routine preoperative chest x-rays: a meta-analysis | journal = Canadian Journal of Anaesthesia | volume = 40 | issue = 11 | pages = 1022–1027 | date = November 1993 | pmid = 8269561 | doi = 10.1007/BF03009471 | doi-access = free }}
* {{cite journal | vauthors = Munro J, Booth A, Nicholl J | title = Routine preoperative testing: a systematic review of the evidence | journal = Health Technology Assessment | volume = 1 | issue = 12 | pages = i–iv, 1–62 | year = 1997 | pmid = 9483155 | doi = 10.3310/hta1120 | doi-access = free }}
* {{cite journal | vauthors = Grier DJ, Watson LJ, Hartnell GG, Wilde P | title = Are routine chest radiographs prior to angiography of any value? | journal = Clinical Radiology | volume = 48 | issue = 2 | pages = 131–133 | date = August 1993 | pmid = 8004892 | doi = 10.1016/S0009-9260(05)81088-8 }}
* {{cite journal | vauthors = Gupta SD, Gibbins FJ, Sen I | title = Routine chest radiography in the elderly | journal = Age and Ageing | volume = 14 | issue = 1 | pages = 11–14 | date = January 1985 | pmid = 4003172 | doi = 10.1093/ageing/14.1.11 | doi-access = free }}
* {{cite journal | vauthors = Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD | title = ACR appropriateness criteria routine chest radiographs in intensive care unit patients | journal = Journal of the American College of Radiology | volume = 10 | issue = 3 | pages = 170–174 | date = March 2013 | pmid = 23571057 | doi = 10.1016/j.jacr.2012.11.013 | url = http://guidelines.gov/content.aspx?id=35151 | access-date = 4 September 2012 | publisher = [[National Guideline Clearinghouse]] | url-status = dead | df = dmy-all | archive-url = https://web.archive.org/web/20120915185449/http://www.guidelines.gov/content.aspx?id=35151 | archive-date = 15 September 2012 }}</ref> However, [[Specialty (medicine)|medical specialty]] [[professional organizations]] recommend against routine pre-operative [[Chest radiograph|chest x-rays]] for people who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray.<ref name="ACRfive"/> Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person.<ref name="ACRfive"/> Likewise, other tests including [[complete blood count]], [[prothrombin time]], [[partial thromboplastin time]], [[basic metabolic panel]], and [[urinalysis]] should not be done unless the results of these tests can help evaluate surgical risk.<ref name="ASCPfive">{{Citation |author1 = American Society for Clinical Pathology |author1-link = American Society for Clinical Pathology |title = Five Things Physicians and Patients Should Question |publisher = American Society for Clinical Pathology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-society-for-clinical-pathology/ |access-date = 1 August 2013 |url-status=live |archive-url = https://web.archive.org/web/20130901115431/http://www.choosingwisely.org/doctor-patient-lists/american-society-for-clinical-pathology/ |archive-date = 1 September 2013 }}, which cites
#* {{cite journal | vauthors = Keay L, Lindsley K, Tielsch J, Katz J, Schein O | title = Routine preoperative medical testing for cataract surgery | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD007293 | date = January 2019 | issue = 1 | pmid = 30616299 | pmc = 6353242 | doi = 10.1002/14651858.CD007293.pub4 }}
#* {{cite journal | vauthors = Katz RI, Dexter F, Rosenfeld K, Wolfe L, Redmond V, Agarwal D, Salik I, Goldsteen K, Goodman M, Glass PS | title = Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests | journal = Anesthesia and Analgesia | volume = 112 | issue = 1 | pages = 207–212 | date = January 2011 | pmid = 21081771 | doi = 10.1213/ANE.0b013e31820034f0 | s2cid = 8480050 | doi-access = free }}
#* {{cite journal | vauthors = Munro J, Booth A, Nicholl J | title = Routine preoperative testing: a systematic review of the evidence | journal = Health Technology Assessment | volume = 1 | issue = 12 | pages = i–iv, 1–62 | year = 1997 | pmid = 9483155 | doi = 10.3310/hta1120 | doi-access = free }}
#* {{cite journal | vauthors = Reynolds TM | title = National Institute for Health and Clinical Excellence guidelines on preoperative tests: the use of routine preoperative tests for elective surgery | journal = Annals of Clinical Biochemistry | volume = 43 | issue = Pt 1 | pages = 13–16 | date = January 2006 | pmid = 16390604 | doi = 10.1258/000456306775141623 | doi-access = free }}
#* {{cite journal | vauthors = Capdenat Saint-Martin E, Michel P, Raymond JM, Iskandar H, Chevalier C, Petitpierre MN, Daubech L, Amouretti M, Maurette P | title = Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital | journal = Quality in Health Care | volume = 7 | issue = 1 | pages = 5–11 | date = March 1998 | pmid = 10178152 | pmc = 2483578 | doi = 10.1136/qshc.7.1.5 }}</ref>