Understanding Who Does Pre-op for Surgery: A Guide to the Multidisciplinary Team

September 24, 2025 •

3 min read

Annually, roughly 15 million Americans undergo surgery, with each procedure requiring a thorough pre-operative assessment. So, who does pre-op for surgery? The answer is not a single person but a coordinated team of medical experts dedicated to ensuring patient safety and optimizing outcomes.

Quick Summary

The pre-operative evaluation for surgery is performed by a collaborative team of healthcare providers, including the surgeon, an anesthesiologist, and specialized pre-op nurses or nurse practitioners. The primary care physician and other specialists may also be involved in providing medical clearance and risk assessment, ensuring comprehensive preparation before a procedure.

Key Points

Team Effort: The pre-operative evaluation involves a multidisciplinary team, including the surgeon, anesthesiologist, and nurses.
Anesthesia Assessment: Anesthesiologists or CRNAs assess anesthetic risk and formulate a personalized plan for patient safety.
Surgeon's Oversight: The surgeon holds ultimate responsibility for preparing the patient, coordinating evaluations, and obtaining informed consent.
Nurse Coordination: Pre-op nurses are key coordinators who gather patient information, review test results, and provide essential patient education.
Medical Clearance: The primary care physician or other specialists may be involved in providing medical clearance for patients with pre-existing health conditions.
Safety First: A thorough pre-op process is crucial for minimizing surgical risks, preventing complications, and ensuring the best possible outcome.
Patient's Active Role: Patients are vital participants by providing a complete medical history, disclosing all medications, and following pre-op instructions carefully.

The Multidisciplinary Team Behind Pre-op Assessments

Modern medicine emphasizes a comprehensive, team-based approach for surgical preparation, moving beyond the historical practice of a simple "clearance" from a primary care physician. This collaborative effort involves several key professionals assessing risk, managing health conditions, and educating patients.

The Anesthesia Team

A vital part of the pre-op team is the anesthesiologist or a certified registered nurse anesthetist (CRNA). Their role includes a detailed evaluation to create a personalized anesthetic plan. This assessment covers:

Reviewing your medical history and past experiences with anesthesia.
Performing a physical examination, with a focus on your heart and lungs.
Evaluating risks related to the procedure and your health.
Discussing anesthesia options like general, regional, or monitored sedation.
Examining laboratory and imaging test results.

The Surgeon's Role

The surgeon is responsible for the overall preoperative preparation. This includes:

Confirming the diagnosis and explaining treatment options.
Obtaining informed consent after detailing risks and benefits.
Initiating and coordinating the pre-operative workup and requesting specialist consultations.

The Pre-op Nurse or Nurse Practitioner

These specialized nurses coordinate patient care and information gathering. They often act as the main point of contact, performing health histories and physical assessments. They also review and order necessary tests like lab work, EKGs, or X-rays and provide crucial patient education on preparing for surgery.

The Primary Care Physician and Other Specialists

For patients with chronic conditions, a medical "clearance" from their primary care physician (PCP) is often requested to ensure conditions like diabetes or heart disease are managed. Specialists such as cardiologists or pulmonologists may also be consulted for complex cases.

The Pre-operative Evaluation Process: A Step-by-Step Guide

Surgeon's Consultation: The surgeon determines the need for surgery and starts the pre-op process by ordering tests and a formal evaluation.
Pre-op Assessment Clinic Visit: You'll visit a clinic or have a consultation with a pre-op nurse to review your medical history and medications.
Anesthesia Evaluation: An anesthesiologist or CRNA evaluates your suitability for anesthesia and discusses options based on your health and test results.
Medical Clearance: Your PCP or a specialist provides clearance, confirming your health conditions are stable for surgery.
Final Instructions: A nurse will contact you before surgery with final details, including arrival time and medication/fasting rules.

The Importance of Pre-op vs. The Risks of Skipping It

Skipping a pre-operative evaluation significantly increases risks. It's a vital safety measure to identify and reduce potential complications.


Aspect	With Proper Pre-op	Without Proper Pre-op
Patient Safety	Risks are minimized through thorough assessment, identifying potential issues before they cause harm.	Increased risk of complications, including cardiac events, respiratory failure, or excessive bleeding.
Anesthesia Plan	The plan is optimized and tailored to the patient's specific health status and needs.	Inadequate planning can lead to adverse reactions to anesthesia, such as unexpected arousals or medication interactions.
Recovery Time	Enhanced recovery protocols and optimization of health can lead to smoother, faster healing.	Delayed recovery, longer hospital stays, and more complicated healing processes are likely.
Procedure Outcome	The likelihood of a successful surgical outcome is maximized by preparing the body for the stress of surgery.	Higher risk of post-operative complications and potentially readmission to the hospital.

The Role of the Pre-operative Clinic

Many hospitals use centralized pre-operative clinics (PACs or PREP Centers) to streamline evaluations and tests. These clinics improve efficiency by bringing the team and services together, reducing delays and enhancing patient satisfaction. This team-based approach is considered best practice in perioperative care.

For example, NYU Langone's Center for Preoperative Care uses a multidisciplinary team to prepare patients for surgery.

Conclusion

The question of who does pre-op for surgery highlights a team of professionals working together for a safe and successful surgical outcome. Each member, from the anesthesiologist assessing risks to the surgeon's oversight and the nurse's patient education, plays a vital role. This collaborative effort ensures thorough assessment and optimization of a patient's health, reducing complications and promoting a smooth recovery.

Frequently Asked Questions

A team of healthcare providers, including the surgeon, an anesthesiologist, and specialized nurses or nurse practitioners, typically handles the pre-operative evaluation to ensure safety and readiness.

The anesthesiologist assesses risks associated with anesthesia, reviews your medical history and test results, and develops a personalized anesthetic plan for your surgery.

Yes, often. Your surgeon or anesthesiologist may request a medical clearance from your primary care physician, especially if you have pre-existing medical conditions like heart disease or diabetes.

A pre-op nurse or NP gathers your detailed medical history, performs a physical exam, reviews lab results, and provides you with essential pre-operative instructions and education.

Depending on your health and the procedure, tests can include blood work, a urine test, an EKG to assess heart function, and imaging tests like X-rays.

It is not recommended to skip a pre-op, even if you feel well. The evaluation is designed to uncover potential risks and optimize your health to prevent complications during and after surgery.

Pre-op care is vital because it identifies underlying medical conditions, minimizes surgical risks, ensures you are fit for anesthesia, and helps streamline your recovery process.

You should bring a list of all your current medications and supplements (including dosages), any recent test results, relevant medical records, and contact information for your doctors.