Preoperative Assessments in Pediatric Surgery

Abstract

Preoperative assessment has been largely influenced by the evolution and popularity of day case surgery, which has been shown to have major advantages over inpatient surgery (Sadler et al. Ann R Coll Surg Engl. 1992;74(2):130–3; Suhonen et al. Int J Nurs Pract. 2007;13:121–29). Pioneering work in the development of day surgery can be attributed to a Scottish pediatric surgeon, James Nicholl, who performed 460 surgeries for harelip and cleft palate in the 1900s. He considered children were more safely nursed at home rather than in the hospital environment (Nicoll and Spina Bifida. Glasgow Med J. 1902;58:12–9). Now, the majority of pediatric elective surgery is performed on a day case basis, and therefore pre-assessment is essential for this service to perform efficiently and effectively. Fundamental to the success of these initiatives is a clear, comprehensive system that relies on a thorough preoperative evaluation tailored to identifying operative risk with access to appropriate investigative modalities and suitably trained staff. However, there are some unique situations in pediatric surgery that require a different approach to preoperative assessment, such as the work-up of a neonate requiring surgery. These aspects of preoperative assessment, and others, will be discussed in detail in this chapter.