PREOPERATIVE TESTING (see Chapter 25 )

Current data suggest that routine testing on the basis of age alone is not indicated. In low-risk procedures such as cataract surgery, routine preoperative testing does not decrease the incidence of intraoperative or postoperative complications (also see Chapter 25 ). For intermediate-risk procedures such as total-hip replacement, studies suggest that healthy patients should undergo selective laboratory testing based on the history and physical examination.^[135] For all types of noncardiac surgery, when patients are 70 years or older, the prevalence of laboratory abnormalities varies with the test. However, significant predictors of adverse outcomes after surgery in the elderly are not specific laboratory abnormalities, but rather ASA status and surgical risk.^[136] These results suggest that routine preoperative testing on the basis of age will have a low yield. Instead, selective testing should be performed on the basis of the history, physical examination, and surgical procedure.