A 36-year-old woman requested a physical examination prior to excision of accessory navicular bone on her right foot, detected on MRI. She has no significant past medical history, but for the past 18 years, she has smoked half a pack of cigarettes daily. What preoperative workup, if any, would you advise for this asymptomatic patient? I presume the surgery will be done under spinal or general anesthesia.
—Suru Shah, MD, Johnstown, Pa.

This healthy young woman does not need any presurgical workup. Do a routine history and physical, including BP and heart rate, review any medications she may be taking—OTC or otherwise—and assess her exercise tolerance. Do a pregnancy test if there is any chance she may be pregnant. Otherwise, there is no evidence to recommend any particular testing, not even “routine blood work” or an ECG, unless specifically indicated by her history and physical. There is actually reason not to do unnecessary testing, as the predictive value in a low risk population is small, with an increased probability of false-positive results and the needless worry and workup that abnormal results can entail.
—Susan Kashaf, MD, MPH (106-14)

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