Preoperative work up: Are the requirements different in a developing country?

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild hypokalemia (>3 mEq/L) was seen in 6/123 (4.8%) and a raised blood sugar level was seen in 1/113 (0.88%) patients. Only one patient with hemoglobin of 4.8 gm/dL needed preoperative intervention, the rest of the abnormalities did not effect the treatment plan or outcome. The results were in general agreement with other studies except for the high proportion of low hemoglobin seen in the female population. It is suggested that a thorough history and physical examination is a reliable and inexpensive preoperative screening tool. Guidelines for pre-operative investigations in American Society of Anesthesiologists Grade I (ASA I) patients are suggested.