Scope and Target Population:

The guideline describes appropriate evaluation for elective, low-risk operative procedures for adult and pediatric patients. Pediatric patients for whom this guideline is intended are those between the ages of 2 and 15 years. Patients over age 15 are considered adults for the purposes of this guideline.

Clinical Highlights and Recommendations

• Provide a comprehensive preoperative basic health assessment for all patients undergoing a diagnostic or therapeutic procedure as defined in the guideline.
  
• Most laboratory and diagnostic tests including ECG's are not necessary with routine procedures unless a specific indication is present.
  
• ECG's are not indicated, regardless of age, for those patients having cataract surgery.
  
• Patients on chronic beta-blocking therapy should continue taking their beta-blocker medication up to and including the day of surgery. If beta-blocker therapy is stopped prior to surgery, patients are at increased risk for complications postoperatively.

Priority Aims

1. Obtain appropriate preoperative history and exam, and reduce diagnostics performed without clinical indications.
   
2. Eliminate canceled or delayed surgical procedures due to lack of appropriate preoperative assessment and reporting.
   

Additional Background:

More than 95 percent of patients having elective surgery require no testing before the procedure if they are without acute or chronic illness documented by a history and physical examination. This guideline acknowledges this observation and stresses a basic history and physical examination as the key events in a preoperative assessment. Further testing is required for certain procedures, positive findings, and age related risks.