1. Type of surgery
2. Patient origin
3. Patient comorbidities
4. Experience of surgeon
Select the correct answer using the code given below.
Preoperative Investigation Factors
Preoperative investigations are the tests and screening protocols ordered before a surgical procedure to evaluate a patient's fitness for anaesthesia and surgery, identify unrecognised disease, and allow risk stratification. The extent and type of workup ordered is individualised, and standard anaesthesia/surgery texts describe it as being guided by the nature of the surgery itself, the patient's background/origin (relevant for endemic infections, genetic and nutritional patterns), and the patient's comorbid conditions. The correct answer is Option B (1, 2 and 3).
Why Statements 1, 2 and 3 Are Correct
- 1. Type of surgery: The magnitude, site, and anticipated blood loss/physiological stress of the planned surgery dictate the investigations needed. A minor day-care procedure needs minimal workup, whereas major cardiothoracic, abdominal, or neurosurgical procedures mandate a much wider battery of tests (e.g., cross-matching, echocardiography, pulmonary function tests) because of the greater derangement they can cause.
- 2. Patient origin: The geographic/ethnic background of the patient is relevant because certain investigations are targeted at conditions endemic to or more prevalent in specific populations — for example, screening for sickle cell disease/thalassemia, tuberculosis, hepatitis B/C, or G6PD deficiency in patients from regions where these are common. This directly affects which additional tests are ordered.
- 3. Patient comorbidities: Pre-existing conditions such as diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease, or respiratory illness are one of the most important determinants of the preoperative workup, since they guide organ-specific testing (ECG, renal function tests, blood sugar profile, chest X-ray, etc.) and overall anaesthetic risk assessment (e.g., ASA grading).
Why Statement 4 Is Incorrect
- 4. Experience of the surgeon: Preoperative investigations are ordered based on objective patient- and procedure-related risk factors, not on the operating surgeon's personal experience or seniority. A surgeon's skill level may influence operative technique or decision-making during surgery, but it is not a recognised criterion for selecting preoperative tests. Including this factor is a distractor and is why options containing "4" (Options A, C, and D) are incorrect.
Conclusion
Since preoperative testing is tailored according to the type of surgery, the patient's origin, and the patient's comorbidities, while the surgeon's experience plays no role in this decision, the correct combination is statements 1, 2 and 3, making Option B the correct answer.
Important Questions from Pre-operative & Post-operative Care
- Which type of surgery is laparoscopic cholecystectomy classified as?
- A 50-year old lady underwent uneventful bariatric surgery for morbid obesity. On the third post operative day, she develops breathless and pulmonary embolism is suspected. The next investigation to confirm the diagnosis will be:
- Which one of the following is NOT a risk factor for development of venous thrombosis in surgical patients?
- Which one of the following is NOT a complication of massive blood transfusion?
- A 20 year old patient underwent open hernia surgery four days back. He is running fever for the last one day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:
