Preoperative Assessment in Neurosurgery: Do More Tests Mean More Safety? Myth or Reality?
In many centers, preoperative assessment is reduced to a fixed list of tests for every patient. The evidence shows that it rarely changes management: in 1,800 elective craniotomies, only 0.5% of coagulation tests were abnormal in patients without prior history, unrelated to blood loss.
The real risk lies elsewhere: frailty, present in almost half of patients, doubles complications; anemia is associated with higher mortality; and antiplatelet and anticoagulant management requires a written plan. Surgery begins with patient triage and clinical condition, and this affects the final outcome.
In this article I review the evidence without bias and explain why every institution needs an integrated perioperative medicine unit, from triage to discharge.
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