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Cutting Risk, Not Just Skin-An International Survey on the Role of Preoperative Lab Values in Risk Stratification for
Michael Alfertshofer1,2, Joanna Kempa-Timler3, Nicholas Moellhoff4
1Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany.
Journal of Clinical Medicine
|November 13, 2025
Summary
Preoperative lab tests are common in plastic and reconstructive surgery (PRS) for risk assessment. Surgeons emphasize hematologic and coagulation labs, showing a need for standardized risk stratification tools in PRS.
Area of Science:
- Plastic and reconstructive surgery
- Surgical risk assessment
- Laboratory diagnostics
Background:
- Plastic and reconstructive surgery (PRS) involves diverse techniques requiring individualized risk assessment.
- Standardized preoperative diagnostics, including lab testing, are crucial for elective PRS procedures.
- The precise role and application of specific lab parameters in PRS risk stratification are not well-defined.
Purpose of the Study:
- To investigate the utilization of preoperative laboratory testing in PRS.
- To characterize current practices, perceived importance, and variability in lab test use for surgical risk stratification.
- To explore the potential for standardized, lab-based risk assessment tools in PRS.
Main Methods:
- An anonymous, web-based cross-sectional survey was distributed to international PRS surgeons.
- Survey items included surgeon demographics, routine preoperative assessment methods, lab test ordering frequency, and perceived importance.
- Data were analyzed with comparisons stratified by work setting, experience, and subspecialization.
Main Results:
- 140 PRS surgeons from 24 countries participated; clinical evaluation (97.9%) and lab testing (84.3%) were primary assessment methods.
- Hemoglobin (80.0%), hematocrit (76.4%), platelets (69.3%), creatinine (68.6%), and WBC count (67.1%) were most frequently ordered.
- Hospital-based surgeons ordered more creatinine, WBC, INR, and albumin tests and deemed albumin more important than private practice surgeons.
Conclusions:
- Preoperative laboratory tests, particularly hematologic and coagulation parameters, are extensively used in PRS across different practice settings.
- A significant consensus exists on the importance of preoperative labs for risk stratification, with openness to standardized tools.
- Harmonizing current practices and integrating specific lab values into standardized, procedure-specific risk stratification is warranted.
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