Junior doctor survival kit
Surgical preoperative assessment
What to do and why
As a newly qualified doctor responsible for preoperative assessment (often called pre-clerking), you are in charge of one of the most important steps in a patient’s pathway to surgery. Although it is often seen as a chore, getting this right is vital for avoiding potentially life threatening perioperative complications, cancelled operations, and wasted theatre resources. Despite this importance, few medical students receive dedicated teaching on preoperative assessment.
Formalised preoperative assessment before admission for elective surgery is now common. Traditionally, patients were admitted the day before surgery for clerking, diagnostic tests, and any specific preparation—for example, bowel preparation or heparin administration. This meant an unnecessary night’s stay, which was expensive for hospitals and inconvenient for patients. Last minute problems identified on admission often resulted in cancellation on the day of surgery. Most commonly this was caused by pre-existing medical conditions—for example, poorly controlled chronic obstructive pulmonary disease—or new ones discovered at