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Are Blood Tests Mandatory Before Surgery?

From reading other stories i was under the impression that i would have blood work done at my pre-surgical appointment. But when i went the nurse went over my history, checked my blood pressure, lungs, heart, etc. and looked down at her paper and said ok your all set to meet with the anesthesialogist your Doctor didn't order any blood work. Is that ok? Should i be concerned? My Tummy tuck and breast augmentation surgery is next week and i am starting to get really nervous.

Doctor Answers (21)

Blood Tests Before Surgery

+7

Many agree that routine blood testing prior to surgery in young, healthy patients (say less than 30 years old) is not necessary.  While to a certain extent that may be true, I feel otherwise.   I require a CBC (complete blood count) prior to surgery on ALL patients.  This is to check for anemia (uncommon but I probably advise 10% of patients to begin iron supplements before surgery) but also to check the white cell count (an indicator of infection) espcially when placing a foreign body (breast implants) during surgery. 

One may have an asymptomatic infection (urinary tract is the most common) and I would like to know that prior to putting in implants to avoid seeding the implants.  An elevated white cell count may be the earliest indicator of this prior to symptoms.  If an implant becomes infected, there is a very likely chance that it's removal may be required in order to adequately treat the infection.  I want to avoid that at all costs.

I do not believe that any other lab tests are required up to the age of 50 (in acccordance with the guidelines of the American Society of Anesthesiologists) unless there are medical conditions that warrant them.  After 50, I require a CBC and EKG (done within a year).  Some surgeons will require only a pregnancy test for child-bearing age females prior to surgery.   Depending on when this is done, this may truly be the most unnecessary test. 

Most physicians require patients to come in for a "Pre-Op" consultation a week or 2 prior to surgery.  If the pregnancy test is done then, then you know that the patient is not pregnant then.  In the interim week or 2 until surgery, the patient could be sexually active and may become pregnant.  If the test is done on the morning of surgery (typically a urine test in the surgical facility, not a blood test),  these are notoriously inaccurate in detecting very early pregnancies (say with in a week or 2), so why bother.  Each surgeon has his/her own opinion about these things and I think you just need to trust what your surgeon recommends you do.


Orlando Plastic Surgeon
4.5 out of 5 stars 7 reviews

Your age and health status is relevant

+4

Not every body need to have blood work and anesthesialogist will follow guide lines based on the surgery, age and risk factors. You should be able to discuss your concerns with your plastic surgeon rather than asking other doctors. You are about to let your surgeon operate on you and you should be able to talk to your doctor freely about any concerns that you have.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 56 reviews

Pre-operative blood tests

+3

In healthy patients younger than thirty a pregnancy test is usually all that is required.  However, some hospitals and surgical centers often require more extensive testing.  For patients older than 30, we generally require a CBC, BMP, and PT/PTT.  If you have any respiratory or cardiac issues, then we require a medical clearance from your medical doctor and also an EKG and a chest Xray.  Your medical doctor may also decide to order more extensive tests as well.  Good luck with your procedure. 

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

Preoperative testing will vary with your surgeon and the facility

+2

Hi there-

For healthy young women (under age 30 with no medical problems) having short procedures with limited blood loss and anesthesia time (breast augmentation), most surgeons and facilities would not require any testing at all, other than a pregnancy test done in timely fashion.

Similarly, most would agree that patients over 40 or 50, or those with medical problems, would benefit from testing before undergoing surgery.

The gray area therefore, is between the ages of 30 and 40....

How to best prepare and evaluate a patient before surgery under these circumstances will depend on your surgeon, his or her experiences in the past, the facility the procedure will be performed in, and the preferences of the anesthesia provider involved in your care.

In other words, it would not necessarily be inappropriate to require some testing under these circumstances- nor would it be inappropriate to NOT require testing if your surgeon, anesthesia provider and facility did not feel it was necessary for you given the procedure you were having.

As I say so very often, your best bet is to do your homework carefully, find a surgeon and situation you like and feel you can trust, and then DO trust that they will recommend what is in your best interests and most likely to keep you safe.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 102 reviews

Blood tests are often unnecessary for tummy tuck and breast augmentation

+2

If you are healthy and relatively young a blood test is not necessary for a breast augmentation or a tummy tuck procedure. Those who are on medication or have a history of anemia deserve a check beforehand, and those with a medical condition may require a checkup by their doctor for a medical clearance for surgery. A 'clearance' means that your medical condition is stable and well managed at the time and will not conflict with your procedure. Chest x-rays are a thing of the past. We do perform a urine pregnancy test on all of child bearing age the morning of the procedure.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

It is better to be safe than sorry with pre-operative blood work

+2

I have all of my patients get blood work if they are having anesthesia. This is true for someone 18 years old to someone 75 years old. A simple work-up is easy to do, minimally inconvenient and can potentially pick up a problem that could be exacerbated by a surgical procedure or anesthetic. It is better to be safe than sorry!

David Rankin, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 50 reviews

Blood work often times is not necessary

+2

In healthy patients under the age of thirty-five, without significant past medical problems, routine blood work isn't usually indicated. Assuming the patient hasn't had a tubal ligation or hysterectomy, the only lab work that we will require is a pregnancy test and that's usually obtained on the morning of surgery.

Hope this helps. Best of luck.

Sam Jejurikar, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 30 reviews

Protocol for Preoperative Testing for Surgery

+1

Breast augmentation and abdominoplasty are components of the mommy makeover which is one of the larger procedures performed in cosmetic surgery. When this procedure is undertaken, safety should always be a priority. The pre-operative evaluation varies from patient to patient and depends on a variety of factors.

The starting point is a comprehensive history and physical examination. Depending on the findings of this evaluation additional studies and consultation may be necessary before proceeding with surgery.

We generally recommend a mammogram on any patient over forty years of age. An EKG is performed on anyone older than fifty. Laboratory studies are performed on an individual basis and depend upon the medical evaluation. The vast majority of patients have CBC’s and pregnancy tests. 

In many cases, consultation with cardiology, pulmonology, and endocrinology are appropriate based on the patient’s medical history.

It’s important to remember that cosmetic procedures are major surgical procedures that have associated risks. For this reason, safety should be everyone’s first priority. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 78 reviews

Blood tests before surgery

+1
In my practice, all patients have blood tests prior to surgery. Older patients have more extensive testing.  Safety is the absolute highest priority. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 41 reviews

Blood Tests Prior To Surgery?

+1
Thank you for the question.
You'll find that every practice has a different routine when it comes to pre-operative appointments. This includes blood tests that are ordered.  For most young, healthy patients minimal to no blood work is necessary. For example, often a hemoglobin check and a pregnancy test may be all that is indicated for a young healthy patient undergoing “mommy makeover” surgery.
In our practice, during the preoperative visit ( typically done several weeks prior to surgery)  patients are given a list of do's and don'ts that will help them get through the surgery and recovery safely.   We review their medical history and obtain any necessary preoperative workup necessary. This may include EKG and/or laboratory values depending on the patient's specific situation.
We will also discuss diagnosis and treatment options/plan as well as the potential risks/complications associated with the planned procedure.  Informed consent is obtained verbally and in written form.
"Dos and don'ts" regarding the use of medications,  alcohol, nicotine,  foods  etc. are reviewed in detail ((before and after surgery)
Prescriptions are provided for postoperative medications after reviewing patient allergies.
Relevant pictures are taken.  “Goal pictures” ( of what the patient wishes to look like,  and NOT  look like) are reviewed again.
Details about the day before (NPO status)  and the day of surgery are reviewed.
Often patients have concerns about anesthesia and these are addressed as well.  They are reminded that they will be treated by well experienced board-certified anesthesiologists who work with our team routinely. They will be monitored very carefully  both in the operating room and in the recovery room.
Patients are often concerned/anxious and we try to provide them with “relaxation techniques” to use prior to surgery.
The patient's aftercare plans are reviewed carefully;  depending on the procedure,  home nursing is also arranged.  The patient's family members/ and friends are engaged and instructed as well.
Whenever possible, I ask to see  patients the day before surgery for preoperative markings.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 726 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.