Preoperative Medicine for the Internal Medicine Clinician: A Review

Internal medicine clinicians are often involved in preoperative evaluation and counseling for their patients, yet explicit training and exposure opportunities in perioperative medicine are limited. Beyond providing clearance for surgery or anesthesiology care, preoperative medical care presents an opportunity for clinicians to use clinical skills, evidence-based medicine, and skilled communication with patients and caregivers to maximize benefit and safety during a planned surgery. This review explores foundations of preoperative medicine to help internal medicine clinicians contribute to safe, high-value, patient-centered preoperative care, including an overview of high-yield resources and professional society guidelines.

Delivery of preoperative medical care requires history, physical examination, interpretation of diagnostic test results, and clinical reasoning, supported by a scaffold of published guidelines and evidence. The preoperative examination begins with carefully reviewing the status of known health conditions and current medications in the context of operative risk, which can lead to recommendations for risk reduction and inform the need for further testing. Further, clinicians should also investigate undifferentiated symptoms and other preoperative risk factors that arise during the evaluation, such as exertional dyspnea and examination findings of volume overload. Finally, the preoperative assessment should include communication of individualized risks and benefits of the planned surgery, engaging the patient in shared decision-making around preoperative preparation. A comprehensive preoperative evaluation can not only help patients prepare for surgery but also inform care provided by the surgical and anesthesiology teams during and postoperatively.

Using an evidence-informed, stepwise approach, internal medicine clinicians can have a beneficial impact on the preoperative course for their patients.