Pre-Operative Assessment — what tests you'll get before surgery
Before any operation, the surgeon needs a clear picture of how your body handles anaesthesia, healing, and the specific stress of the procedure planned. At Dr. Khaled Ghalwash and Dr. Mohamed Ghalwash's practice in Alexandria, the workup is two layers: the standard panel every patient receives, and a personalised set of additions chosen from the patient's profile.
Five patient profiles change the workup beyond the standard panel: cardiac history, diabetes, age over 50 with chronic cholecystitis, current smoker, and BMI above 40. Each is described in its own section below with the protocol Dr. Khaled Ghalwash uses, the relevant 2024 to 2026 guideline references, and what the result changes about the operation itself.
The two-tier protocol
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1
Standard panel — every patient
CBC, coagulation profile, kidney function, liver function, electrolytes, fasting glucose with HbA1c, viral screen, ECG, and chest X-ray when indicated. The floor that exists regardless of procedure.
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2
Personalised add-on by profile
Diabetic patients add HbA1c targets, fasting insulin, and HOMA-IR when indicated. Cardiac patients add echocardiogram, with stress testing only when the result will change management. Age over 50 with chronic cholecystitis adds CT abdomen with IV contrast plus MRCP.
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3
Surgeon review with the patient
Dr. Khaled Ghalwash interprets every result against the planned procedure, not in isolation. The plan is adjusted where indicated. Patients leave the consultation knowing what each test showed and how it shapes their operation.
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4
Optimisation window
If glucose, blood pressure, or coagulation is suboptimal, the date is moved by 2 to 4 weeks rather than proceeding marginally. The protocol is optimisation, not clearance. Most patients are fitter on the day of operation than they were on the day they walked in.
Dr. Khaled Ghalwash adds tests not for completeness, but to find the one fact that changes how the operation is done. A normal result reassures, but it is the abnormal one we are looking for, because that is the one that matters.
Personalisation triggers — when the workup expands
| Patient profile | Add to standard panel | Why it matters |
|---|---|---|
| Cardiac history (CAD, AFib, prior MI, stent, valve) | Echocardiogram. Stress test only if result will change management (2024 AHA/ACC Class IIb). | Anaesthesia stresses the heart. Echo confirms resting function. Stress is reserved for when ischaemia would alter the plan. |
| Diabetes (type 1 or type 2) | HbA1c, fasting insulin, HOMA-IR (when indicated), microalbuminuria, fundoscopy referral, GLP-1/SGLT2/Metformin handling plan. | HbA1c < 8% is the 2025 ADA target for elective surgery. Higher = optimisation window. |
| Age > 50 with chronic cholecystitis | CT abdomen with IV contrast plus MRCP. | Ultrasound sensitivity for Mirizzi syndrome is 23–46% in this profile. Combined CT + MRCP reaches 96%. |
| Current smoker | Pulmonary function test for major surgery, smoking-cessation referral 4–8 weeks pre-op. | Smoking ≥1 pack-year doubles wound infection and pulmonary complication risk. The optimisation window pays back. |
| BMI > 40 | Sleep study (OSA screen), echocardiogram, extended electrolyte panel, anaesthesia consult. | OSA is undiagnosed in roughly half of patients with BMI > 40. Anaesthesia plan changes accordingly. |
Read your profile in detail
Each profile has its own page with the protocol Dr. Khaled Ghalwash uses, the 2024 to 2026 guideline references, and the FAQs patients ask the most.
When tests are done in the timeline
Most pre-operative tests are valid for 4 to 12 weeks. Booking the operation is the trigger to start the workup, not the other way round. A typical timeline:
- 4 to 8 weeks before surgery: standard panel, baseline imaging, specialist referrals if needed (cardiology, anaesthesia consult for high-risk profiles).
- 2 to 4 weeks before surgery: optimisation window for any abnormal value (glucose, blood pressure, anaemia, coagulation). Repeat tests confirm correction.
- 1 week before surgery: medication review, GLP-1 and SGLT2 stop, anticoagulation plan finalised.
- Day before surgery: fasting instructions, day-of glucose plan for diabetic patients, final consent.
What to bring to consultation
Patients come prepared so the consultation is spent on planning, not gathering. Bring:
- Original printed reports of any blood tests, ECGs, or imaging from the past 12 months.
- Complete list of current medications, including injections, supplements, and herbal products. GLP-1 (Ozempic, Mounjaro) and SGLT2 (Forxiga, Jardiance) matter especially.
- Cardiology, endocrinology, or other specialist letters if you are followed for a chronic condition.
- Imaging discs (with the actual image files), not just the reports. Dr. Khaled Ghalwash reads the images himself.
Frequently asked questions
How long are pre-operative tests valid?
Standard blood work is valid for 4 weeks before elective surgery. ECG and chest X-ray are valid for 6 months in stable patients. Cardiac echocardiogram is valid for 12 months unless symptoms changed. Dr. Khaled Ghalwash reviews timing on every patient.
Do I have to use a specific lab?
No. Any accredited lab is acceptable, provided you bring original printed reports. We do recommend specific imaging centers for CT and echocardiogram only when image quality has been a problem at other centers.
What happens if a test result is abnormal?
It depends on which test, by how much, and your planned procedure. Most abnormal results lead to optimization, not cancellation. We rarely cancel surgeries. We routinely postpone by 2 to 4 weeks to bring values into the safe range.
Do I need to fast for the blood draw?
Yes for the metabolic panel, lipid panel, fasting glucose and HOMA-IR. 8 to 12 hours of fasting. Water is allowed. The viral screen and CBC do not require fasting, but most labs draw all tubes together.
Are these tests covered by insurance?
In Egypt, most pre-operative testing is paid out of pocket. The standard panel ranges 800 to 1,500 EGP at typical labs. Imaging is separate. We send you with a clear list before any tests are ordered so there are no surprises.
Schedule with Dr. Khaled Ghalwash and Dr. Mohamed Ghalwash
Book your pre-operative consultation. We send you a clear list of tests before any are ordered, review every result with you, and adjust the surgical plan based on what we find.
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