# Cutting Risk, Not Just Skin—An International Survey on the Role of Preoperative Lab Values in Risk Stratification for Plastic and Reconstructive Surgery

## TL;DR

This study surveyed plastic surgeons worldwide to understand how preoperative lab tests are used to assess surgical risk, finding widespread use and a desire for standardized tools.

## Contribution

The study identifies current practices and consensus on the importance of preoperative lab values in plastic surgery risk stratification.

## Key findings

- Clinical evaluation and lab testing are the most common risk assessment methods in plastic surgery.
- Hemoglobin, hematocrit, platelets, creatinine, and white blood cell count are the most frequently ordered lab tests.
- Hospital-based surgeons order more labs and rate albumin as more important compared to private practice surgeons.

## Abstract

Background/Objectives: Plastic and reconstructive surgery (PRS) is characterized by its wide range of techniques and procedures, aiming to address the need for individualized treatment approaches. As PRS is predominantly performed in an elective and non-emergency setting, a thorough preoperative risk assessment through standardized diagnostics remains essential. Lab testing is often routinely performed, yet its overall role and how specific parameters are currently used to stratify risk in PRS is poorly understood. We herein aim to explore the role of preoperative lab value testing and characterize current practices, perceived importance, and variability in their use for risk stratification. Methods: We conducted an anonymous, web-based cross-sectional survey of international PRS surgeons. Survey items captured demographics, routine preoperative assessment methods, ordering frequency of laboratory tests, and their perceived importance. Group comparisons were stratified by work setting, years of experience, and PRS subspecialization. Results: A total of 140 PRS surgeons from 24 countries completed the survey. Clinical evaluation (97.9%) and laboratory testing (84.3%) were the most common risk assessment methods investigated in our study; 70.7% agreed that preoperative lab values are important for surgical risk stratification while 64.3% would adopt a standardized lab-based risk assessment tool. The most ordered lab tests were hemoglobin (80.0%), hematocrit (76.4%), platelets (69.3%), creatinine (68.6%), and white blood cell count (67.1%). Hospital-based PRS surgeons ordered creatinine, WBC, INR and albumin more often and rated albumin of greater importance compared with PRS surgeons based in private practice. Conclusions: Preoperative labs are widely used in PRS with emphasis on hematologic and coagulation parameters, in both hospitals and private practices. Broad consensus on the importance of preoperative lab values in surgical risk stratification and a willingness to adopt a standardized, lab-based risk assessment tool highlight the need to harmonize current practice and integrate specific labs into standardized procedure-specific risk stratification.