EKG: (within 6 months) - age 50 or over, HTN, DM and over 40 with cardiovascular disease or > 2 risk factors for CAD, significant renal, thyroid, or other metabolic disease, and surgical category 5.
CHEST X-RAY: (within 1 year) - Debilitating lung disease or significant worsening in past 6 months; cardiac or thoracic procedure; surgical category 5.
SERUM CHEMISTRIES (M-7): (within 1 month)- Renal disorders; adrenal or thyroid disorders; DM, diuretic, chemotherapy or treatment that may affect chemistries; surgical category 5.
URINALYSIS: (within one month) - DM; renal disorders; G-U procedure; recent UTI; surgical category 5.
CBC (within one month) - Heme disorder, vascular procedure, chemotherapy, surgical procedure 5.
COAGULATION STUDIES (immediately prior) - Anticoagulation Rx, vascular procedure, surgical category 5.
PREGNANCY TEST (within 1 week) - At risk patients for whom pregnancy may complicate the procedure or uncertain status.

No testing or exam prior to the day of surgery may be required in some patients: eg, most children, generally healthy adults <50 with surgical category 1 or 2. (Generally healthy adults >50 with surgical category 1 or 2 may only require a preoperative EKG.

Category 1 - Minimal risk, minimal blood loss (ie, minor outpatient procedure
Category 2 - Mild risk, blood loss <500 cc (eg, laparoscopies, hernias, superficial procedures)
Category 3 - Moderate risk, blood loss 500 - 1500 cc (eg, joint replacements, open abdominal surgery)
Category 4 - Major risk, blood loss > 1500 cc (eg, major spinal surgery, GI, GU and vascular surgery)
Category 5 - Critical risk, blood loss > 1500 cc (eg, cardiothoracic, intracranial, radical procedures)

Class 1 - Generally healthy, localized pathologic process
Class 2 - Stable mild to moderate systemic condition (eg, smoker, HTN, obesity, PG, DM, asthma, >70)
Class 3 - Moderately severe systemic disorder (eg, poorly controlled disorders, hx of CAD, dysrhythmia)
Class 4 - Severe and clearly life-threatening disorder (eg, recent MI, unstable angina, severe CHF or COPD, hepatic or renal failure)
Class 5 - Little chance of survival; procedure performed in desperation.

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