Preoperative Form

The preoperative form captures all pre-anaesthesia assessment data. It is the first step in every case.

Mobile section dashboard

On mobile, the preoperative form opens with a section dashboard. It shows seven sections — Patient, Case, Meds & Safety, Airway, Vitals, Risk, and Labs — with a completion indicator for each. Tap any section to open its focused editor. Use Back to sections to return to the overview.

A sticky section rail at the top lets you jump between sections without going back to the dashboard. A side scroll indicator marks your position in longer sections.

Pediatric cases

Select Pediatric for patients from birth to under 18 years and record age in days, months, or years. For a child under one year, answer whether the child was born prematurely. If yes, enter gestational age at birth as completed weeks plus additional days. LOSPOR calculates postmenstrual age; it is read-only. Pediatric mode uses ASA, POVOC, conditional COLDS, age-aware vital references and the nil-by-mouth assignment (below). Adult RCRI, Apfel, STOP-BANG and Gupta are hidden. Body surface area, maintenance fluid and the resuscitation doses are worked out from the record and shown in the intraoperative record.

Nil by mouth for a child

For each intake (clear fluids, breast milk, infant formula, solid food or cow's milk), record how many hours before surgery the child stops. This is the instruction given at the visit, not a record of the last meal.

• One tap: Assign APAGBI 2023 hours fills in the minimums: 1, 3, 4 and 6 hours.
• Shorter assignments are flagged.
• Clock times: once surgery has started, the intraoperative record shows the assignment as clock times ("clear fluids until 07:30").
• Consent: the printed consent's fasting list uses these hours.

See Pediatric mode for safety limits and rollout status.

Patient demographics

Enter the patient's:

• Age (years)
• Sex (Male / Female / Other)
• Height (cm) and Weight (kg) — BMI is calculated automatically
• Blood type and Rh factor (optional)

IBW (Ideal Body Weight) and ABW (Adjusted Body Weight) are calculated automatically from height, weight, and sex. These are important for drug dosing in obese patients.

Mobile numeric entry

On mobile, numeric fields use different controls depending on clinical context:

• Age, height, weight, and airway distances — an iOS-style wheel picker for fast scrolling, with an optional custom keypad for precise entry.
• Vitals (blood pressure, heart rate, SpO₂, etc.) — minus/plus steppers with a thin slider, plus a custom keypad accessible by tapping the value.

Both comma (8,5) and dot (8.5) decimals are accepted.

Case details

• Diagnosis — search by ICD-10 code, English label, Bulgarian label, or clinical synonym. The local ICD-10 database is enriched with ICD-10CM clinical synonyms (e.g. searching "heart attack" returns I21 Acute myocardial infarction). Results show the clinical group name as the primary label and the ICD code below it.
• Planned procedure — search for the surgical procedure. Results show the procedure group as the primary label and its section below it. The group alone is a valid answer.
• Exact operation (optional) — once a group is chosen, the field below it lists the ICD-10-PCS operations inside that group (open or laparoscopic, whole or partial, and so on). Type a few words to narrow the list, then pick one. The list works offline too. The exact operation is what research uses: a group alone has no research code, an exact operation has its own. The record and the printed sheet then name it, for example "Cholecystectomy: Resection of Gallbladder, Percutaneous Endoscopic Approach [0FT44ZZ]".
• A procedure imported from the hospital system (hospital appliance) — shows the hospital's own code and wording. Operations that the hospital code points to are listed first and marked; picking one keeps the hospital's code beside it. A hospital code a clinician has reviewed and confirmed to mean exactly one operation arrives already set to that operation.
• Team notes (optional) — free text for roles, theatre number, or any case-specific reminders. Do not enter names or ID numbers here.

On mobile, both searches use inline dropdown autocomplete — results appear below the search field without opening a separate screen.

Comorbidities

Select active comorbidities from the ICD-10 list. Multiple comorbidities can be added. They appear as chips that are displayed on the printed protocol.

Safety fields

• Allergies — tick if the patient has known allergies, then describe them in the text field
• Latex allergy — separate checkbox due to its anaesthetic relevance
• Current medications — free text
• Family anaesthesia problems — tick if there is a family history of malignant hyperthermia or other relevant conditions

Airway assessment

The airway section covers all standard pre-anaesthesia airway evaluation parameters:

Field	Description
Mallampati class	I–IV, selected visually
Mouth opening (inter-incisor distance)	in cm
Thyromental distance	in cm
Neck mobility	Full / Limited / Fixed
Upper lip bite test (ULBT)	Class I / II / III
Cormack–Lehane grade	I / IIa / IIb / III / IV
Difficult airway history	Flag + free text for details

Preoperative vitals

Record the patient's vital signs at the time of assessment:

• Blood pressure (systolic / diastolic, mmHg)
• Heart rate (bpm)
• SpO₂ (%)
• Temperature (°C)
• Respiratory rate (/min)
• ECG rhythm

Risk scores

ASA classification (required) — I through VI, with an emergency modifier (ASA-E).

ASA suggestion. From the coded diagnoses and comorbidities (WHO ICD-10) and the BMI, LOSPOR suggests a class and names the conditions behind it, in your language.

• When it shows: it stays until you choose a class. It is shown only when there is evidence: nothing coded and a normal BMI suggests nothing, not ASA I.
• Children: the adult BMI rule does not apply to them.
• Research: the suggestion is stored beside the class you chose, so research can see how often the two agree.

The following scores are calculated automatically as you fill in the relevant sections of the form:

Score	What it predicts
RCRI (0–6)	Major adverse cardiac events
Apfel (0–4)	Postoperative nausea and vomiting (PONV): about 10, 20, 40, 60 and 80 % for 0 to 4 factors; 0 is low, 1–2 medium, 3 or more high (PONV consensus guidelines)
STOP-BANG (0–8)	Obstructive sleep apnoea risk

Each score's colour follows its own band.

Gupta cardiac risk (when the hospital switches it on)

The Gupta MICA model estimates the risk of a myocardial infarction or cardiac arrest within 30 days of surgery, for adults.

• Questions: the card appears when the hospital switches on its two questions, functional status and procedure type.
• Other inputs: age, ASA and creatinine come from the record. No creatinine result counts as the model's "unknown".
• Procedure type: offered from the planned procedure; you confirm it.
• Missing inputs: a missing input is named, never guessed.
• Result: a risk of 1 % or more reads as elevated. Only the inputs are saved; the percentage is worked out wherever it is shown or exported.

Planned anaesthesia (optional)

On the risk section you can record the anaesthesia planned at the visit, in the intraoperative record's own menus: the techniques, airway devices and instruments, lines, and whether ventilation is planned after the operation. The preop summary prints it, and the written consent fills its planned-anaesthesia line from it.

When a score is not available

On a hospital appliance, the hospital can switch off a standard question. A score that needs a switched-off answer shows not available instead of a number, because counting an unasked criterion as "no" would understate the risk.

Questions your hospital adds (hospital appliance)

A hospital appliance can ask more than the standard form. Its administrator chooses the questions from a catalogue that ships with LOSPOR (see Preoperative questions); no one can type in a question of their own.

• Each added question appears as a Yes / No row in the section it belongs to: most in the anamnesis, swallowing and sleep-related breathing under the airway, a pacemaker or ICD and difficult venous access under the examination, pregnancy and breastfeeding with the patient details. Some also offer Unknown or N/A. A few offer their own choices instead, such as Gupta's functional status and procedure type.
• A question asked only from an age (alcohol use, from 14) is left off a younger patient's form, check and summary.
• A follow-up question appears only after you answer Yes to the question above it. Answering anything else removes it and its answer.
• A question marked * is required. A draft always saves; required questions are checked when you continue to the intraoperative form.
• Questions without * are recommended only: leaving one blank does not stop you continuing. The hospital administrator can set this independently for each enabled question, including the 30 baseline questions.
• From the record: Yes? under a question is a suggestion drawn from the imported hospital record. Accept it to use it as the answer, or reject it. It is offered only while the question is unanswered, so it never replaces your own answer.
• A counter at the top of each section shows how many of its questions are answered.

The questions and their order are the same on the web and on the phone, and in the tabbed and the scrolled layout.

The hospital has one profile for adults and one for children. A paediatric case follows the children's profile and an adult case the adults', so the same question can be required for children and optional for adults. Switching a case's mode switches the form to the other profile's questions straight away.

The preop summary (when the hospital switches it on)

A hospital can add a summary page between the preoperative and intraoperative records. Continue then opens the summary, where you can:

• keep the case or hand it over;
• print the summary, and the written consent when the hospital uses it; and
• start the intraoperative record, or go back and edit the preop.

On a phone that is offline, the flow goes straight from preop to intraop. See Protocol & Printing for what prints.

Laboratory results

The Labs section contains a catalogue of 100+ perioperative-relevant tests organised across nine categories:

Category	Examples
Haematology	Hb (g/L), Hct (ratio), WBC, Platelets, MCV, full differential
Coagulation	PT/INR, aPTT, Fibrinogen, D-dimer
Electrolytes	Na⁺, K⁺, Cl⁻, Ca²⁺, Mg²⁺, Phosphate
Biochemistry	Creatinine, eGFR, Glucose (mmol/L), HbA1c, Lactate
Liver	ALT, AST, ALP, GGT, Bilirubin, Albumin
Cardiac	Troponin, CK-MB, BNP, NT-proBNP
Blood Gas	pH, PaO₂, PaCO₂, HCO₃⁻, BE, SaO₂
Thyroid	TSH, Free T4, Free T3
Inflammatory	CRP, ESR, Ferritin, Procalcitonin

To add a result manually: click a category to expand it, click a test name to add it to the results table, then enter the value. The unit is pre-filled automatically.

To search: type in the search box above the categories — the list filters in real time.

Reference ranges: each result is compared to a standard reference interval. Values within range are shown in green; out-of-range values are flagged in amber with the value bolded. The flag is informational — clinical interpretation is always the clinician's responsibility.

AI lab scan

Scanning needs the case's AI consent: tick Allow AI assistance for this case (see AI assistance). Without it the phone says so in place of the camera buttons. Click Scan lab report to upload a photo or scan of a printed laboratory result. Mistral AI reads the image and extracts test names, values, and units into a preview panel. Check the results you want to import and click Add selected. Tests already in your list are skipped automatically.

The AI scan recognises only tests in the LOSPOR catalogue and normalises all values to canonical units (e.g. Hb in g/L, glucose in mmol/L). Any result the AI extracts that does not match a catalogue entry is silently discarded — only recognised, correctly-named results are shown in the review panel.

On mobile, Scan lab report supports both camera capture and gallery upload. Extracted values are shown in a review sheet before anything is added to the case. Manual lab search and value entry remain available.

Privacy

Lab images are sent to the configured AI provider for text extraction. Avoid uploading images that show patient names or ID numbers. A notice is displayed above the upload button as a reminder.

All entered lab results appear in the printed protocol.

Premedication

Record premedication in two phases: The day before (the day before surgery) and Morning before surgery. Pick the drug, dose and route; there is no clock time. For research each entry is exported as its coded drug, dated the day before or the day of the operation.

AI assistance and the pre-operative advisor

At the bottom of the preoperative form, Allow AI assistance for this case records the case's consent to AI. It is off by default, and it covers every AI feature the hospital has switched on: the lab report scan, the monitor scan and the advisor. It is shown whenever at least one of them is on, paediatric cases included; with every AI feature off it is not shown at all.

If a scan fails, the message names the reason: no consent on the case, an image that is too large or of the wrong type, too many scans in the last hour, an AI model the hospital must change in Status, AI not set up, or a reading that took too long.

The advisor is for adults only. With consent given, click the AI Clinical Analysis button to receive a structured pre-operative assessment covering ASA classification, technique recommendation, airway management, preparation, and drug considerations.

Privacy

Only structured clinical fields are sent to the configured AI provider. Free-text fields (team notes, airway notes, family history details) are never forwarded. Your consent is recorded in the audit log.

Saving

The preoperative form auto-saves as you work: taps on pills, toggles, and checkboxes save almost immediately, while typed fields save about a second and a half after you stop typing. Only the fields you actually changed are sent, so two clinicians editing different parts of the same case no longer overwrite each other.

If the connection drops, your changes are kept locally and sync automatically when it returns — a "saves waiting" badge appears in the header (web) or the sync indicator shows queued (mobile) until everything has reached the server.

When all mandatory fields are complete, click Save & continue or Continue to intraoperative to move to the intraoperative form. If required fields are missing, the app lists all of them at once, in the order of the form, and opens the form at the first. On a hospital appliance, required questions the hospital added are checked at the same moment, and the app lists any that are still unanswered.

Reaching the summary is not the same as finalizing the case. Close Now runs the server's completeness check. If preoperative demographics are still missing, the summary names that issue (age, sex, height, or weight) so you can return to the preoperative form and correct it.

If the server refuses a save (for example a value it will not accept), the app says so beside the field rather than showing the change as waiting to sync.