Optimizing postoperative outcomes with efficient preoperative assessment and management

Objective: To review the essential features of preoperative assessment, management, and planning, with special emphasis on high-risk patients who are likely to have manifestations related to their co-existing disease and disease treatment(s) in the postoperative setting. Data Source. Review of recent studies and reviews as reprinted in Index Medicus. Conclusions. The major shift in preoperative assessment and management from within the hospital to outside the hospital has prompted new efforts to coordinate preoperative care. Much of this can be accomplished with the introduction of a preadmission testing center. Under the direction of a physician (typically an anesthesiologist), the Pre-Admission Testing Center staff performs necessary assessments and coordinates necessary information about the presurgical patient. This assessment should include features essential to the general history and physical examination, as well as the specific issues related to anesthesia and surgery. The preoperative visit is also an opportunity to perform directed laboratory testing (as opposed to across the board batteries of tests) and to carefully plan out the continuance, discontinuance, or initiation of medications in the perioperative period. It also may be beneficial to stabilize disorders such as hypertension and, when indicated, initiate preoperative optimization of patients with advanced disease. The ultimate goal is to provide safe and "efficient" care, without exhausting highly valued intensive care resources.