Preoperative Risk Evaluation and Assessment

The primary goal of fast track protocols is to enhance postoperative recovery by decreasing morbidity, mortality, length of stay, and return to full function. An important component of limiting postoperative morbidity and mortality is evaluating and assessing preoperative risk. The underlying medical conditions of patients as well as their functional status form a big component of preoperative risk, which in turn is a determinant of postoperative outcomes. The preoperative history and physical examination form the backbone of preoperative risk assessment. This will direct which further tests are necessary to complete the preoperative evaluation. The underlying conditions that pose the greatest risk include cardiovascular disease, pulmonary disease, diabetes mellitus, underlying immunosuppression, incident infections, and functional status. There are various disease-specific risk assessment tools and indexes that help to risk-stratify patients in each disease category. Based on these indexes, several algorithms have been developed to help determine what preoperative testing is required, if any. The accurate evaluation and assessment of preoperative risk will ensure that patients are optimized before surgery to decrease the incidence of postoperative morbidity and mortality, and thereby enhance recovery.