What preoperative assessments are recommended for patients undergoing elective cardiothoracic surgery?

For patients undergoing elective cardiothoracic surgery, a comprehensive preoperative assessment is recommended to optimise surgical outcomes and minimise perioperative risks. This assessment should include a detailed clinical evaluation incorporating cardiovascular, respiratory, renal, and metabolic status.

Cardiovascular assessment should include a resting electrocardiogram (ECG) for all patients, as it is a fundamental screening tool. Resting echocardiography is not routinely recommended but should be considered if the patient has a heart murmur combined with cardiac symptoms such as breathlessness, chest pain, syncope, or signs of heart failure. The ECG findings should be reviewed in consultation with an anaesthetist before ordering echocardiography ¹. Additionally, risk stratification tools like Thoracoscore may be used to estimate perioperative mortality risk in lung cancer patients undergoing surgery, ensuring informed consent ². Surgery should be avoided within 30 days of a myocardial infarction ².

Respiratory assessment is critical given the nature of cardiothoracic surgery. Lung function tests including spirometry (measuring peak expiratory flow rate, forced vital capacity, and forced expiratory volume) and arterial blood gas analysis should be performed to evaluate pulmonary reserve and gas exchange capacity ¹. Smoking cessation advice and support should be provided promptly, as smoking increases pulmonary complications risk, but surgery should not be delayed solely for smoking cessation ².

Laboratory tests should include a full blood count to assess haemoglobin and platelet levels, kidney function tests (estimated glomerular filtration rate, electrolytes, creatinine), and haemostasis tests to evaluate bleeding risk ¹. Glycated haemoglobin (HbA1c) testing is recommended for patients with diabetes if not recently tested, but not routinely for those without diabetes ¹. Urine tests are not routinely required unless a urinary tract infection would influence surgical decisions ¹.

Additional considerations include pregnancy testing for women of childbearing potential on the day of surgery, with appropriate counselling and consent ¹. Testing for sickle cell disease or trait is not routinely recommended unless there is a known history or family history, in which case specialist input is advised ¹.

Preoperative optimisation should involve lifestyle modification discussions, including smoking cessation and alcohol reduction, and use of enhanced recovery programmes for major or complex surgery ³. A validated risk stratification tool should supplement clinical assessment to guide shared decision-making ³.

In summary, elective cardiothoracic surgery preoperative assessment integrates clinical evaluation, targeted cardiovascular and respiratory investigations, relevant laboratory tests, and patient-centred risk stratification and optimisation strategies to ensure safe and effective perioperative care ¹,²,³.