Dear Doc, Am I Cleared for Surgery?

Preparing for cosmetic surgery is serious business. The following is a copy of a letter we have patients give to their primary-care physicians to obtain the right medical clearance for plastic surgery. You can use it as a guideline to discuss with your own doctor to help ensure you’re in good health prior to surgery

Dear Doctor:

Your patient has made the voluntary decision to undergo a surgical procedure. In order to ensure patient safety, we would like to obtain your surgical clearance before we proceed with the surgery. The patient will be receiving general anesthesia for an outpatient procedure that will last approximately one to five hours. Most plastic surgery procedures are considered low to moderate risk.

Specifically, we would like the patient to be evaluated for at least the following items. Any other evaluations that would affect the patient, per your complete history and physical, which you deem necessary, are at your discretion. Thank you for your assistance in our goal of providing excellent patient care in the safest possible environment.

1. Cardiac evaluation: We would require at least an EKG. If you feel the patient’s EKG or cardiac risk factors warrant a stress test, echo, angiogram, or other test, please obtain as well. Electrolyte levels, especially if the patient is on any medications, would be excellent. Hypertension must be under good control to proceed.
2. Vascular evaluation: If you feel that the patient is at risk for a CVA or other vascular complication, a carotid Doppler or other examination should be obtained.
3. Pulmonary evaluation: If there is any indication to obtain a chest X-ray, ABG, or PFT, please do so. All patients should be encouraged to stop smoking and avoid all forms of nicotine before their procedure.
4. Diabetes evaluation: Since diabetes can cause healing difficulties, we would like the patient to be under good control when about to undergo a procedure. The HgA1c test results should be under seven within six months from the date of surgery. In addition, medication alteration may be necessary per your guidelines to prevent peri-operative hypoglycemia.
5. DVT/PE prophylaxis: All patients who are to undergo a major liposuction or abdominoplasty will receive 40 mg of Lovenox prior to the procedure. Any other suggestions you have, based on the individual patient’s risk factors, would be appreciated.
6. Preoperative anemia: We have noticed that many patients are anemic prior to surgery. An Hg/Hct and PT/PTT would be helpful during your examination to evaluate and correct any deficiencies well in advance of any surgical procedure.
7. Post-gastric bypass patients: As you know, these patients occasionally have severe electrolyte, hydration, and anemia issues. Please complete a comprehensive metabolic profile and CBC to evaluate and begin to treat vitamin and iron deficiencies as indicated
8. Other:_________________________________________________________________________

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Of course, the preoperative clearance should not be limited to only the above evaluations. If you feel that there are other issues that preclude surgery, or should be brought to our attention, please do not hesitate to contact us. We truly appreciate your assistance in this matter. After your evaluation, if you could have your office fax us copies of the EKG, lab work, history and physical, and a note from you, stating you feel it is okay to go ahead with the procedure, we would appreciate that.

Sincerely,

Dr. Shah
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Learn more about how to prepare for your procedure(s) in my book, “Making the Cut” available for purchase on Amazon.

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