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INTRODUCTION

Preoperative evaluation of patients undergoing cutaneous surgery serves multiple purposes: (1) it provides patients and physicians with the opportunity to discuss pertinent risks, benefits, and alternatives for the planned procedure; (2) to identify significant patient, lesion, or surgical factors that could increase the risk of complications; and (3) to plan care so as to mitigate identified risk factors.

The extent of preoperative evaluation depends in part on the type of procedure, the duration and degree of invasiveness of the procedure, and the use of topical, local, or general anesthesia. The vast majority of dermatologic surgeries are conducted under local anesthesia. A brief questionnaire addressing major risk factors for bleeding, infection, allergies, and implantable cardiac devices that may limit the use of electrocautery devices, will typically suffice for superficial procedures such as biopsies and curettage. Surgical excisions and Mohs micrographic surgery require a more thorough investigation of the patient’s past medical history and lesion(s) of interest to identify and appropriately mitigate possible complications. Preoperative evaluation for elective cosmetic procedures such as laser therapies, liposuction, hair transplant, sclerotherapy, injections of fillers, and botulinum toxins varies significantly depending on the procedure and will, therefore, be covered in their corresponding specific chapters.

GENERAL OVERVIEW

A thorough preoperative evaluation provides a global overview of patient factors that can complicate the planned surgical procedure: past medical and surgical history, medications, allergies, and social history and habits (Table 2-1). Diabetes, cardiovascular heart disease, immunosuppression, blood-borne infections, bleeding disorders, and neuropsychiatric conditions are medical conditions that may influence operative planning. All prior surgeries, surgical complications and outcomes, and the presence of prosthetic joints or implantable cardiac devices should be specifically elicited from the patient.

TABLE 2-1Preoperative Assessment of Surgical Patients

Obtaining an accurate medication record is crucial but challenging, especially in the elderly population, whose medication lists can be extensive. It can be helpful to confirm the medication list on record with the patient and his or her caregiver, given the varying degrees of compliance and to inquire specifically about over-the-counter medications and herbal supplements as these are often underreported. Information ...

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