Many patients who are hospitalized for surgery in gynecology always have questions about the bunch of blood draws and various tests done before surgery: I just came for a gynecological surgery, what is the use of doing these tests?
Here, we will take a simple hysterectomy surgery as an example to tell you what are the pre-operative examinations and what is the use of checking these.
I. Physical examination and medical history
Every patient has to go through this process before surgery.
On the first day of hospitalization, when you arrive at the ward, you must first report to the nurse’s station, and after registering your information, the nurse will take your blood pressure, heart rate, respiratory rate, weight and temperature.
Then the patient goes to the bed to rest and within 2 hours a bedside doctor will come to ask about the patient’s symptoms, whether there are various underlying diseases, previous physical conditions, and to check the patient’s body.
Don’t underestimate these processes. By understanding the medical history, the doctor can have a more intuitive impression of the patient’s condition and grasp information that may be commonplace to the patient but important to the doctor.
Therefore, the patient needs to know everything to the doctor.
Second, various laboratory tests and examinations
1.Laboratory items
The purpose of the laboratory tests and examinations that need to be completed before the operation is as follows.
Routine blood tests: to determine whether the patient has anemia, infections, hematological diseases, etc;
Urine routine: whether there is urinary tract infection, kidney disease;
Blood biochemistry: to understand liver and kidney function and blood glucose and lipid levels;
Coagulation: surgery will be traumatic, if the body’s hemostatic function is not good, can not do surgery;
Pre-transfusion immunization: whether there is hepatitis B, hepatitis C, AIDS, syphilis infection, if there is infection, the operating room medical staff and equipment need to be prepared in advance;
Blood type, cross-matching: when the operation may require blood transfusion, blood type should be tested and cross-matching should be done to prepare in advance.
2.Checkup items
First, each patient must have the following two kinds of tests.
Electrocardiogram: It can reflect some heart problems that the patient is not aware of, and some problems need to be treated before surgery;
Chest X-ray: preliminary determination of no obvious abnormalities in the lungs.
In addition, cervical cytology (TCT), and cervical HPV testing are required.
If the patient is older, an echocardiogram and pulmonary function tests are also required to further understand the function of the heart and lungs, and no significant abnormalities in cardiopulmonary function are required before surgery. Patients undergoing laparoscopic hysterectomy will also need ultrasound examinations: kidney, ureter, and bladder.
These are the routine pre-operative tests that patients do not know much about and doctors do not have time to explain in detail.
Are these tests overmedicated?
The starting point for the development of such routine tests is to have a comprehensive understanding of the patient’s condition and to reduce the risk of surgery, while taking into account the principle of modest costs.
Patients often have two types of questions about these tests.
The first one: I just came in to have a fibroid removed, I’m in good health, why so many tests? Is it over-medication?
In the face of this doubt, after reading the above explanation of each test, I believe you have realized the necessity of these tests: without any of them, the patient may be put at greater risk during the operation.
The second one: these tests are not enough! A thousand dollars to fool people. Can you check more thoroughly?
These are routine preoperative tests designed to reduce the risk of surgery. If these tests suggest abnormalities, we will choose more specialized tests depending on the disease.
It is true that doing more and more advanced preoperative tests can improve the detection rate of diseases, but it means a greater expense. At the same time, such tests do not screen out disease at a high rate and seem to be a bit overkill.
For example, there is a real-life case like this.
A person was hospitalized for uterine fibroids, and the available routine preoperative tests did not reveal a relatively small lung cancer in the lungs. After the hysterectomy, the patient was discharged without incident, and six months later, the lung cancer had progressed to an advanced stage.
Does this require the hospital to include CT in the routine preoperative examinations as well?
It is true that in detecting early lung cancer, a few tens of dollars of chest X-ray is not as high as hundreds or thousands of dollars of CT. But should hospitals include chest CT scan as a routine preoperative examination in order not to miss the diagnosis?
I don’t think so.
Because it may take 1,000 patients with gallbladder stones to have one such missed diagnosis; it is clearly unreasonable to give CT to all 999 other patients just because of one person.
Now, do you understand what is the purpose of the test before the surgery?