A patient came in last month, nervous, with a knee replacement scheduled in three weeks. Her surgeon's office had told her she needed "medical clearance," and she'd been losing sleep wondering if I was going to find something that would cancel the whole thing. I hear this a lot. So let me start with the reassuring part: most of the time, the goal isn't to stop your surgery. It's to make sure you sail through it.
A pre-operative risk assessment is a focused medical review I do before you go under anesthesia. It looks at your heart, your lungs, your medications, and your overall health to spot anything that could complicate the operation or the recovery. In my Direct Primary Care practice here in Los Angeles, I think of it as a conversation that happens to come with a stethoscope.
What is a pre-operative risk assessment, exactly?
It's a structured evaluation that estimates how well your body will tolerate surgery and anesthesia. I review your medical history, examine you, and order only the tests that actually change the plan.
The word "stratification" sounds clinical, but it just means sorting risk into buckets — low, moderate, higher — so the surgical team knows what to watch for. Someone healthy having a quick outpatient procedure needs very little. Someone with heart disease facing a long operation needs more attention. The assessment matches the workup to the person.
Why do I need surgical clearance from my primary doctor?
Because your surgeon and anesthesiologist need a clear picture of your whole health, not just the body part they're operating on. They're experts at the procedure itself. I'm the one who knows your blood pressure history, your medication list, and how your last year has gone.
Here's what I'm usually looking at:
- Heart and circulation — chest pain, shortness of breath, or known cardiac history
- Lungs — asthma, COPD, sleep apnea, or recent infections
- Blood sugar control, especially with diabetes
- Bleeding risk and clotting
- Every medication and supplement you take
That last one matters more than people expect. Blood thinners, certain diabetes drugs, and even over-the-counter supplements may need to be paused or adjusted before surgery. A careful medication reconciliation can prevent a delayed surgery or an avoidable complication.
What tests are part of a pre-op evaluation?
It depends entirely on you and the surgery — there's no one-size-fits-all panel. I order tests based on your age, your conditions, and how big the operation is.
For many patients, that means a basic set of labs and sometimes a heart tracing. A pre-op EKG can be useful if you have cardiac risk factors or you're over a certain age. Pre-op labs often check blood counts, kidney function, and clotting. If your blood pressure or blood sugar hasn't been well controlled, I want to know that now — not on the morning of surgery.
What I try hard to avoid is unnecessary testing. A perfectly healthy 30-year-old getting a minor procedure usually doesn't need a stack of labs and scans. Ordering tests "just in case" tends to create false alarms and stress, not safety.
How do I prepare for the appointment?
Bring three things: your complete medication and supplement list, the details of your scheduled surgery, and any recent records from specialists.
If you've had heart issues, breathing problems, reactions to anesthesia, or trouble with bleeding in the past, tell me plainly. None of it is too small to mention. I often tell patients that the boring details — the supplement you almost forgot, the cough that lingered last winter — are exactly the ones that turn out to matter.
It also helps to come with questions. Can I keep taking my morning pills? When should I stop eating? What about my inhaler? Walking out with clear answers is half the point.
What happens after the assessment?
Once I've reviewed everything, I send a clearance note to your surgical team that summarizes your risk and any recommendations. Sometimes that note simply says you're good to go.
Other times, we have a little homework first — fine-tuning your blood pressure, getting your blood sugar steadier, or coordinating with a cardiologist. When that's the case, I'll explain why in plain language, and we'll work the timeline so it doesn't derail your surgery date. I'm credentialed at Cedars-Sinai, so coordinating that kind of follow-up is usually straightforward.
Surgery is a big deal, and a little worry going in is completely normal. My job is to take some of that worry off your plate by making sure your body is as ready as it can be. If you have a procedure on the calendar and want a thorough, unhurried evaluation, I'd be glad to help — reach out to my office and we'll get you scheduled with plenty of time to spare.