Please send copies of ALL TESTS with patient to Ortho Preop Visit

OR fax to 415-379-5582 ATTN: Ortho PREOP EVAL

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• Recommendations derived from national consensus guidelines using available evidence to support best                 practices and through agreement between orthopedic, anesthesia and medical services at SFVAHCS

• Labs within 3 months of surgery are acceptable unless there is a significant change in condition or any              unstable medical problem—then obtain within ~2 weeks of procedure

• TOTAL KNEE, HIP, SHOULDER or ANKLE REPLACEMENTS (TJA=total joint arthroplasty) generally require CBC/Chem7 within 3 months & ECG within 6 months of surgical date 

• ARTHROSCOPY:  No pre-op laboratory/studies indicated in most cases

• Our providers will order type and screen and some serologies locally.  Please send most recent results of          previous HIV, HBV, and HCV serologies from your local records 

 

TEST                                                                            Indication(s)  

CBC         Most TJA patients require            Significant blood loss expected, signs or symptoms of anemia,

                                                                          known anemia, myeloproliferative/hematologic disorder or other

                                                                          malignancy, myelotoxic agents, mod-severe cardiac, pulmonary,                                                                             renal disease, history of bleeding, EtOH abuse, poor exercise                                                                                   tolerance

 

Lytes/     Most TJA patients require            CKD, CHF, liver disease, meds affecting lytes, adrenal disease,

BUN/Cr                                                            DM, HTN, urologic procedures, cardiac disease, meds affecting                                                                               renal function planned contrast use, advanced age >75yr

 

ECG         Most TJA patients require             known CAD (done within 6 wks of surgery), known cardiac risk                                                                                         factors (done within 6 mo of surgery), >60y (done within 12 mo)

 

Cardiac Risk Factors:  DM, CHF, CVD, CKD, high risk surgery (cardiac/vascular procedures, prolonged surgery >4h) anticipated significant blood loss, known arrhythmias, prolonged QT, meds that affect QT, HTN and HTN meds, severe pulmonary disease

                                                                                           

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PT/PTT                      Bleeding history, established or suspected liver disease, anticoagulant use,

malnutrition, long  term antibiotic use, heavy EtOH use

 

LFTs                           Established or suspected liver disease (transaminitis, documented hepatitis (viral,

alcoholic, fatty) or cirrhosis), bleeding history, heavy EtOH use

 

UA                             Signs or symptoms of urinary tract infection, urologic procedures

Hgb A1c                   Obtain within 3 months of surgery for all diabetics, within 1 month for poorly controlled

                                  or recent changes in medication regimen

 

CXR                            Active pulmonary symptoms, unstable cardiac/pulm disease OR getting shoulder

                                   replacement, > 60y & no CXR in past 12 months (all three must apply)

 

TTE                             Severe AS, pulm HTN (PASP >50) if no TTE in 1 year, known or suspected valvular

 disease (new murmur) or heart failure if no previous TTE in past year, or if change in  symptoms, exercise tolerance              

 

Myocardial Perfusion Study     Use 2014 ACC/AHA guidelines to determine need for testing, in general, MPS

only done when significant CRFs (RCRI>2) and/or known CAD PLUS poor exercise tolerance