A patient came to me last spring, two weeks out from a knee replacement, holding a one-page form her surgeon's office had handed her. "They told me to get medical clearance," she said. "I have no idea what that means." She's not alone. Most people hear "you need clearance for surgery" and picture a rubber stamp. It's more than that. A good pre-operative evaluation is a careful look at the whole person before the operating room, and done well, it can make your surgery safer and your recovery smoother.
Here in Los Angeles, where I'm credentialed at Cedars-Sinai, surgeons send patients to me precisely because they want a second set of eyes on the things that don't show up in an orthopedic or surgical visit. Your blood pressure. Your heart. Your medications. The cough you've had for a month and keep meaning to mention.
What does a pre-operative evaluation actually check?
A pre-operative evaluation is a structured review of your medical condition to confirm you're ready for anesthesia and surgery, and to catch anything that could raise your risk. I'm not re-diagnosing you. I'm asking a focused question: is there anything here we should know about, fix, or watch closely before the day of surgery?
In my practice, that usually means a few things working together:
- A targeted history and physical — what surgery you're having, your past medical history, how you tolerate exertion.
- Pre-op labs when they're warranted, not as a reflex. The right tests depend on you and the procedure.
- An EKG when your age, symptoms, or heart history call for one.
- A close look at your medication list, including supplements people forget to mention.
Notice what's not on that list: a giant battery of tests on everyone. Over-testing leads to false alarms and delays. The goal is the right workup for you.
Why do I need medical clearance before surgery?
You need clearance so your surgical team can plan for your specific risks instead of being surprised by them in the OR. Surgery and anesthesia put real stress on the body. Most people sail through. But conditions like high blood pressure, type 2 diabetes, or heart and lung disease change the math, and they're far easier to manage when we know about them ahead of time.
Take blood sugar. If your diabetes is running high, your risk of infection and slow wound healing goes up. We have weeks to tune that. The morning of surgery, we don't.
Same with a heart you haven't checked in a while. A simple conversation about how many flights of stairs you can climb tells me a surprising amount about your cardiac risk.
How do I prepare for my pre-operative appointment?
Bring three things, and you'll make the visit twice as useful: a complete medication list, the name and date of your surgery, and any recent test results or specialist notes you have on hand.
I mean everything in that medication list. Prescriptions, yes, but also the daily aspirin, the fish oil, the herbal sleep aid, the supplement a friend recommended. Some of these thin the blood or interact with anesthesia, and a few may need to pause before surgery. That's a decision we make together, never on your own.
If you smoke, tell me. Even a short window of cutting back before surgery can lower your risk of breathing complications and help wounds heal. No lectures from me — just a plan.
What happens if the evaluation finds a problem?
Finding something isn't bad news — it's the entire point. Better to learn your blood pressure is poorly controlled in my office than to discover it on the operating table.
Depending on what turns up, I might adjust a medication, order one more test, or loop in a cardiologist or pulmonologist. Because I coordinate with subspecialists including Cedars-Sinai, that handoff is usually quick. Sometimes the answer is simply "you're in great shape, go ahead." That's a perfectly good result too, and one I get to give often.
I also stay in your corner after the procedure. Clearance isn't the end of the relationship — your recovery and follow-up matter just as much, and I'd rather know how you're healing than guess.
A few honest caveats
No evaluation removes all risk. What it does is shrink the surprises and make sure the right people know the right things before the day arrives. And nothing here is a substitute for advice tailored to you — that's what the visit is for.
If you have surgery on the calendar and aren't sure where to start, I'd genuinely like to help. Reach out to the practice and we'll set aside the time to go through it together, unhurried, so you can walk into your procedure feeling prepared rather than anxious. That peace of mind is part of the medicine.