Fundamentals of Patient Preparation for the Operating Room in the Twenty-First Century
Preoperative preparation is essential in order to optimize outcomes and decrease complications, mortality, and length of stay of the surgical patient. With the adoption of the concept of enhanced recovery after surgery, there is an increased emphasis on the preoperative phase of care recognizing that if patients are in optimal condition preoperatively, they are more likely to recover more quickly postoperatively. Patient education is also an important part of their care as there is also an increased emphasis on self-management in ERAS protocols.
Preoperative assessment of the patient is important in order to confirm the diagnosis and plan the procedure. This may include diagnostic imaging and laboratory tests. In addition, comorbidities such as diabetes and heart disease should be identified and treated if necessary. In recent years, there has been some evidence that the preoperative status of patients can be improved by considering smoking cessation, prehabilitation, nutritional supplements, and blood conservation when applicable. In addition, patients having colorectal surgery may have unique needs including mechanical bowel preparation and siting of stomas in those where a stoma is a possibility. Finally, there is greater emphasis on preparation on the day of surgery including introduction of shorter fasts and interventions to decrease surgical site infections and venous thromboembolisms. As well, surgical checklists which have been shown to increase communication in the operating room among members of the perioperative team are now a part of the routine in most centers.
KeywordsEnhanced recovery after surgery Preoperative assessment Patient education Guidelines
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