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What is it about ?
An operation is often one of the possible treatments for a given disease. Deciding whether or not to have an operation depends on a large number of factors, such as age, the presence of other diseases, general health, the wishes of the patient, etc.
This is why there is always a preoperative evaluation during which it is checked whether the intervention is desirable, whether the benefits are sufficiently great in terms of the expected quality of life and whether sufficient safety can be guaranteed during and after the procedure. surgery.
The operative risk is determined by the physical and mental state of the person concerned, the nature of the disease and its treatment, as well as by anesthesia. Based on this assessment, the patient is best prepared for the operation.
Questioning and examination
The doctor asks detailed questions (anamnesis) and performs a thorough clinical examination; this is extremely important for a correct assessment. The general practitioner is aware of all the relevant medical data. He is in the best position to assess the patient’s condition. He will inform the surgical team and the anesthesiologist. The latter can thus also correctly assess the surgical risk.
Based on the history and physical examination, the person is classified according to their physical condition using the ASA (American Society of Anesthesiologists) score:
- ASA 1: normal patient, in good health, non-smoker, not consuming or consuming little alcohol.
- ASA 2: patient with mild illness who is under control and has no impact on daily functioning. For example, smoking, moderate alcohol consumption, pregnancy, obesity (BMI 30-40), high blood pressure, or diabetes that is well under control.
- ASA 3: patient with severe illness or one or more moderate to severe illnesses. For example, morbid obesity (BMI> 40), COPD, pacemaker, history of heart attack or stroke.
- ASA 4: patient with serious illness that can be life-threatening. Eg. heart attack (infarction), serious problems with the valves of the heart, sepsis.
- ASA 5: patient who will probably die without the operation.
Additional tests
Depending on the ASA score, the type of operation and the heart risk, the doctor may order additional tests (for example, blood tests, electrocardiogram (ECG), chest x-ray).
Here are some basic rules:
- For healthy people under 50 who have an ASA score of 1, no further testing is necessary.
- In healthy people over 50 and in all those with an ASA score of 2, 3 or 4, baseline blood tests and an ECG are done.
- The blood tests requested depend on the nature of the disease and its severity.
- People with lung disease should also have their lungs x-rayed.
- Heart patients must pass a stress test.
- In principle, people with an ASA score of 5 are no longer eligible for surgery due to their limited life expectancy. A possible intervention is only palliative, it is therefore intended to alleviate suffering.
Decision to operate
The final decision as to whether to operate rests with the surgeon. Based on the results of the anamnesis, the clinical examination and any additional examinations, the anesthesiologist and the surgeon will adjust their strategy if necessary. For example, they can take steps to prepare patients at higher risk for the operation, such as adjusting medications.
It is decided whether the operation can be performed in the day hospital or whether hospitalization is necessary. The operation will not take place in the day hospital if it is an open abdominal operation, if the person has an ASA score of 3 or 4, is extremely obese or has heavy alcohol consumption or drugs. After the operation, the necessary appointments are made for rehabilitation and treatment.
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