Preoperative Evaluation

Abstract

The preoperative evaluation is a critical aspect of dermatologic surgery that lays the foundation for safe and high quality surgical outcomes. In addition to establishing rapport with the patient, the preoperative evaluation allows the surgeon to anticipate the complexity of the case and make any necessary adjustments to the operative plan based on the patient’s presenting lesion, past medical history, current medications, and allergies. A standard medical history form can facilitate the preoperative evaluation, although each patient’s unique history should be discussed in detail. Particular attention should be paid to cardiac conditions and implantable cardiac defibrillators, which require special precautions when using electrosurgical techniques. Although anticoagulants such as warfarin may increase the incidence of local bleeding complications, there is a documented risk of serious or fatal thrombotic complications when these medications are interrupted in the perioperative period. As such, therapeutic anticoagulants and cardiac medications such as beta-blockers are continued throughout the perioperative period in most cases. While the use of preoperative antibiotics in dermatologic surgery is controversial, recent American Heart Association guidelines limit prophylactic antibiotics only to those patients with cardiac conditions at highest risk for endocarditis undergoing surgery with breach of the oral mucosa or on infected cutaneous sites.