Preoperative management

Last updated: November 3, 2023

Summarytoggle arrow icon

The purpose of a preoperative evaluation is to assess whether a patient is medically optimized for the stress of surgery and to identify reversible factors that may increase the perioperative risk for the patient. Important components of the preoperative evaluation are a thorough history and physical examination, identification of patients at greatest risk of a perioperative adverse event, and appropriate diagnostic testing. Preoperative preparation enhances surgical outcomes by improving the patient's functional status, mitigating identified risk factors, and optimizing perioperative medication regimens. This includes optimization of medical treatment, specialty consultation for advanced disease management, patient education on lifestyle modifications, and instruction on day-of-surgery oral intake and medication use. The extent of patient evaluation and preparation varies according to both the proposed surgery and the patient's functional status. Low-risk patients having low-risk surgery seldom need testing or intervention, while patients with a high disease burden having high-risk surgery often require extensive testing, consultation, and possible postponement of surgery. Patients having emergent surgery still require evaluation even though opportunities for management beyond resuscitation are typically limited.

See also “Postoperative management.”

Overviewtoggle arrow icon

A preoperative evaluation is performed to determine whether a patient is in optimal health for a planned surgical procedure and its extent depends on the urgency of the surgery.

Approach [1][2][3]

The following applies primarily to patients having elective surgery. See “Emergency preoperative evaluation” for patients needing emergency surgery.

Evaluate the procedural risk and the patient's health and functional capacity in order to: decide whether to proceed with surgery without delay, obtain further testing and/or specialist consultation, or consider delaying or canceling the procedure. [1][2]

Multidisciplinary team roles

  • Medical practitioner [1][2]
    • Determines if the patient is medically optimized for the surgical procedure
    • Initiates measures to optimize the patient's health if necessary
    • Alerts the perioperative team to special health concerns and abnormal test results
  • Surgeon
  • Anesthesiologist: chooses the appropriate anesthetic technique based on patient health and procedural requirements

Emergency preoperative evaluation [8][9]

Patients who need emergency surgery often require simultaneous resuscitation and assessment (e.g., via an ABCDE approach).

Preoperative evaluation of a patient having emergency surgery includes assessing the adequacy of ongoing resuscitation. Continuous reassessment of critical organ function (e.g., tissue perfusion, oxygenation, coagulation) may be necessary.

Evaluating surgical procedural risktoggle arrow icon

Procedures associated with a > 1% risk of a perioperative major adverse event require more intense preoperative evaluation than lower-risk procedures. [10]

Type of surgical procedure

Morbidity and mortality are associated with the duration of surgery, the anatomical site of surgery, the effect of the surgery on organ perfusion during the procedure, and blood loss. [1][11]

Perioperative mortality by type of surgery [12][13]
Risk Examples


(< 1%)




(> 5%)

Urgency of the surgery

The risk of perioperative morbidity and mortality increases as the urgency of the surgery increases and the time available for clinical evaluation and medical intervention decreases. [1][10][14]

  • Emergency surgery
    • Timing: performed as soon as possible due to threat to life or limb.
    • Perioperative mortality: 3.7% at 30 days
  • Urgent surgery
    • Timing: performed within 24–48 hours due to threat to life or limb
    • Perioperative mortality: 2.3% at 30 days
  • Time-sensitive surgery (e.g., oncologic surgeries)
    • Timing: performed within 1–6 weeks to avoid negative outcomes
  • Elective surgery
    • Timing: performed within 12 months
    • Perioperative mortality: 0.4% at 30 days

Evaluating patient healthtoggle arrow icon

Goals [15]

  • Assess whether current acute and chronic illnesses are being optimally managed.
  • Begin treatment of untreated or undertreated medical conditions.
  • Identify high-risk patients who may benefit from:
    • Advanced diagnostic testing
    • Medical specialist referral
    • Delay in surgery
    • Higher levels of postoperative care, e.g., ICU admission

Red flags on the preoperative clinical evaluation

A complete medical history and thorough physical examination are performed in all patients having a preoperative evaluation. Special attention should be paid to red flags for conditions that may increase perioperative risk.

Preoperative clinical red flags [1][16]
System History Physical findings


  • Open wounds or skin breakdown
  • Atypical head and neck anatomy (e.g., micrognathia, radiation-induced scarring)
  • Implanted devices (e.g., automated implantable cardiac device)
  • Cognitive impairment
  • Neurological deficits

Preoperative functional capacity assessment [10][15][17][18]

Limited functional capacity is associated with an increased risk of perioperative morbidity and mortality. Several techniques are available to estimate functional capacity. [1][19]

  • Subjective patient reporting of exercise capacity [10][19][20]
    • Technique: The patient's subjective report of attainable activity is reported in the metabolic equivalents (METs) associated historically with that activity.
      • Activities associated with ≥ 4 METs
        • Climbing a flight of stairs
        • Walking up a hill
        • Performing strenuous household tasks
      • Activities associated with < 4 METs
        • Walking at 2–3 mph
        • Golfing with a cart
        • Slow ballroom dancing
    • Findings: Exercise capacity of < 4 METs is associated with increased risk of perioperative complication
  • Duke Activity Status Index (DASI) [17][20]
    • Description: a validated, self-administered questionnaire that assesses the patient's functional capacity [21]
    • Technique: A 16 item questionnaire completed by the patient results in a score of 0–58
    • Findings: A DASI score ≤ 34 predicts an increased risk of major perioperative adverse events.
  • Cardiopulmonary exercise testing (CPET) [22]
    • Technique: Laboratory measurement of the patient's maximum VO2 during exercise
    • Findings: No clear threshold for increased perioperative risk has been established using CPET data.

A patient who cannot achieve and maintain 4 METs is at an increased risk for perioperative complications. Additional evaluation may be warranted. [10]

A DASI score ≤ 34 consistently predicts an increased risk of major perioperative adverse events. [20]

Risk stratification toolstoggle arrow icon

Validated risk stratification tools identify which patients may benefit from medical intervention, preoperative diagnostic testing, and/or consultation prior to intermediate or high-risk surgery. The derived scores from these tools also allow quick communication about patient risk between perioperative team members.

The American Society of Anesthesiologists (ASA) classification [15][23]

  • Description: classification based on subjective reporting of the severity of the patient's comorbid disease
  • Clinical application: all perioperative patients
  • Key finding: An ASA status ≥ 3 is associated with ≥ 1% perioperative risk of mortality; the patient may be considered at high risk.

American Society of Anesthesiologists physical status classification system (ASA-PS) [23][24]

ASA status Definition Thirty-day mortality [25]
  • Healthy patient
< 0.1%
II < 1%
III 1–2%
IV ∼ 10%
V > 50%


  • Emergency surgery (appended to grades I–IV)

Revised cardiac risk index (RCRI) [26][27]

Revised cardiac risk index (RCRI) [26]
Category Risk factors

National Surgical Quality Improvement Program (NSQIP) surgical risk calculator [10][28]

  • Description: web-based patient and surgery-specific risk calculator developed by the American College of Surgeons (ACS)
  • Key finding: reports predicted risk for 11 individual perioperative complications, including death and MACE

Myocardial infarction and cardiac arrest (MICA) risk calculator [10][29]

  • Description: calculator using 5 patient-related inputs (including ASA status) and procedure site
  • Key finding: estimated risk of 30-day mortality; greater predictive power than RCRI but requires more time to calculate

Diagnosticstoggle arrow icon

Approach [1][8][16]

Order diagnostic testing based on the combined risk derived from surgical procedural risk evaluation, preoperative clinical evaluation, and preoperative risk stratification tools. Avoid broad, nondirected testing. [2]

Investigations for intermediate- or high-risk surgery

Preoperative testing for intermediate- or high-risk surgery [1][8][16]
Study Indication
Platelet count
  • Liver disease
  • Hematologic disorders
Basic metabolic panel

Fasting glucose and hemoglobin A1c

Liver function tests (LFTs)
Coagulation studies
Blood grouping and crossmatching
  • Significant blood loss is anticipated. [31]
Pregnancy test
  • Women of childbearing age with uncertain pregnancy status
ECG [10]
CXR [10]

If the preoperative evaluation reveals a previously undiagnosed or undertreated medical condition, further investigation and treatment should be initiated prior to elective surgery if possible.

Cardiac evaluation and managementtoggle arrow icon

Coronary artery disease (CAD)

Management approach for known or suspected CAD [10]

Advanced testing for CAD [10][27][32]

Preoperative stress testing, CT coronary angiography, and coronary angiography in asymptomatic individuals remain controversial. [32][33]

In asymptomatic patients, perform advanced cardiac testing only when results will affect the decision to operate or the perioperative management.

Elective surgery after coronary angioplasty [35][36]

Discontinuation of P2Y12 receptor blockers (and sometimes aspirin) may be required before surgery. In patients with a cardiac stent, the risks of stent thrombosis must be balanced against the risk of bleeding or delaying surgery.

In patients with a coronary stent, discuss holding aspirin perioperatively with the surgeon; discontinuation is often not required.

Other conditions

Pulmonary evaluation and managementtoggle arrow icon

General principles

Disease-specific interventions

  • Acute respiratory tract infection [2][40][41]
    • An acute infection increases the risk of perioperative pulmonary and airway complications.
    • Consider delaying surgery to treat the infection.
  • Obstructive sleep apnea (OSA) [42][43]
    • Screen all patients for OSA using a validated tool, e.g., STOP-BANG.
    • Evaluate and document CPAP and BIPAP use.
    • Optimize treatment of moderate to severe OSA that is untreated or undertreated. [43]
  • Chronic pulmonary disease (e.g., asthma, COPD) [1][43]
    • Stable pulmonary disease and adequate oxygenation: Further testing is typically not necessary.
    • Unstable pulmonary disease, impaired oxygenation or ventilation: Consider delaying surgery to allow for further assessment and treatment.
  • Advanced COPD [1][44]

Evaluation and management of other systemstoggle arrow icon

Malnourishment [45][46][47]

Malnutrition is associated with a higher risk of postoperative mortality and morbidity, e.g., infectious complications and ICU admission. Arrange formal dietary assessment for all patients with risk factors or signs of malnutrition on screening. [45][48][49]

Hepatic disorders [1][50][51]

Hematologic disorders [2]

Endocrine disorders

Neurological disorders

Renal disorders

General principles [63][64]

Management of CKD [63][64]

Prevention of postoperative AKI [63][64]

CKD is associated with increased postoperative complications and mortality and is a risk factor for developing postoperative AKI. [63][65]

Connective tissue diseases (CTDs)

General principles [73]

  • The risk of postoperative complications (e.g., cardiovascular, infection, VTE) is increased in patients with:
  • Delay elective surgery when possible until disease control has been optimized.
  • Consider preoperative specialist consultation to assist with assessment and management of perioperative risks, e.g.:
    • Rheumatology
    • Cardiology
    • Pulmonology
    • Anesthesia

Screening for cervical spine instability

Perioperative management of immunosuppressive therapy [73][75]

Both CTDs and the medications used for their treatment can increase the risk of postoperative complications. [76]

Patients with cervical spine instability due to CTDs have an increased risk of injury during endotracheal intubation, e.g., for general anesthesia. [73]

Preoperative medication managementtoggle arrow icon

Tailor the decision to continue or discontinue medications to the patient's individual risks and benefits, especially for cardiac and CNS drugs. See also “Perioperative management of oral anticoagulants” for further details on VKAs and DOACs.

Perioperative medication management [2]
Medication General recommendation
Cardiac [10]

Beta blockers

Calcium channel blockers



  • Continue.
  • Hold 24 hours before surgery. [77]
Hematologic Antiplatelet agents [10][78]
Anticoagulants [79][80]
Endocrine [81]


  • Short-acting (e.g., regular, aspart, lispro): Hold the morning of surgery.
  • Intermediate-acting (e.g., NPH): Give 50% of the usual dose the morning of surgery.
  • Long-acting (e.g., glargine, detemir): Give 60–80% of the usual dose before surgery.
  • Premixed (e.g., NPH/regular human 70/30)
    • Blood glucose > 200 mg/dL: Give 50% of the usual morning dose.
    • Blood glucose ≤ 200 mg/dL: Give 50% of the intermediate or long-acting component.
  • Insulin pump: Continue basal infusion at 60–80% of the usual rate.
Oral antidiabetics
Estrogens, progestins, and androgens
  • Continue.
  • Continue.
Thyroid hormones
  • Continue.

Parkinson medications


Psychotropic drugs other than MAOIs

  • Typically continue. [82]
MAOIs [83]
  • Typically discontinue 2–3 weeks prior to surgery after discussion with the prescriber.
NSAIDs [84][85]
Opioids [86][87][88]
Others [89] Conventional DMARDs
  • Continue.
  • Hold after discussion with the prescribing service.
  • Continue.
Herbal medications [90]
  • Typically discontinue ∼ 1 week prior to surgery.

Antianginal medications, antiepileptics, statins, antihypertensive drugs (except ACE inhibitors, ARBs, and diuretics), and neuroleptics should be continued on the day of surgery.

Preoperative preparation measurestoggle arrow icon

Instruct all patients on recommended perioperative medication changes, oral intake on the day of surgery, and lifestyle modifications that may reduce perioperative risk.

Preoperative lifestyle modifications

  • Smoking cessation: Patients should be encouraged to stop smoking, ideally 4–8 weeks or longer before surgery. [91][92]
  • Alcohol use: Chronic alcohol use is associated with numerous perioperative complications. [93]
  • Exercise: Preoperative exercise programs (often called prehabilitation) may improve some surgical outcomes. [97][98]


  • Fasting guidelines for elective surgery [99]
  • Protracted NPO status or preoperative hypovolemia: Correct any volume deficit and replace any ongoing fluid loss with IV fluid therapy.

Perioperative antibiotic prophylaxis [100][101]

Special patient groupstoggle arrow icon

Preoperative management in pregnant individuals [1][102]

Preoperative management in patients with opioid use disorder (OUD) [86][87][88]

Preoperative management in older adults [60][104]

Preoperative assessment (laboratory studies, cardiac testing) is not routinely required before low-risk surgery (e.g., cataract surgery) regardless of the patient's age. [105]

Preoperative management in pediatric patients [106][107]

Preoperative management is generally similar to adults, with some modifications.

Related One-Minute Telegramtoggle arrow icon

Interested in the newest medical research, distilled down to just one minute? Sign up for the One-Minute Telegram in “Tips and links” below.

Referencestoggle arrow icon

  1. Auron M, Duran Castillo MY, Garcia OFD. Perioperative management of pregnant women undergoing nonobstetric surgery. Cleve Clin J Med. 2020; 88 (1): p.27-34.doi: 10.3949/ccjm.88a.18111 . | Open in Read by QxMD
  2. Bierle DM, Raslau D, Regan DW, Sundsted KK, Mauck KF. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clinic Proceedings. 2020; 95 (4): p.807-822.doi: 10.1016/j.mayocp.2019.04.029 . | Open in Read by QxMD
  3. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. The American Journal of Surgery. 2005; 190 (3): p.467-473.doi: 10.1016/j.amjsurg.2005.03.033 . | Open in Read by QxMD
  4. Ward EN, Quaye AN-A, Wilens TE. Opioid Use Disorders. Anesthesia & Analgesia. 2018; 127 (2): p.539-547.doi: 10.1213/ane.0000000000003477 . | Open in Read by QxMD
  5. Harrison TK, Kornfeld H, Aggarwal AK, Lembke A. Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy. Anesthesiol Clin. 2018; 36 (3): p.345-359.doi: 10.1016/j.anclin.2018.04.002 . | Open in Read by QxMD
  6. O’Rourke MJ, Keshock MC, Boxhorn CE, et al. Preoperative Management of Opioid and Nonopioid Analgesics: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clinic Proceedings. 2021; 96 (5): p.1325-1341.doi: 10.1016/j.mayocp.2020.06.045 . | Open in Read by QxMD
  7. Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016; 222 (5): p.930-947.doi: 10.1016/j.jamcollsurg.2015.12.026 . | Open in Read by QxMD
  8. Kumar C, Salzman B, Colburn JL. Preoperative Assessment in Older Adults: A Comprehensive Approach.. Am Fam Physician. 2018; 98 (4): p.214-220.
  9. Miller KM, Oetting TA, Tweeten JP, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2021; 129 (1): p.P1-P126.doi: 10.1016/j.ophtha.2021.10.006 . | Open in Read by QxMD
  10. Goldschneider KR, Cravero JP, et al. The Pediatrician’s Role in the Evaluation and Preparation of Pediatric Patients Undergoing Anesthesia. Pediatrics. 2014; 134 (3): p.634-641.doi: 10.1542/peds.2014-1840 . | Open in Read by QxMD
  11. Fletke KJ, Kaysin A, Jones S. Preoperative Evaluation in Children.. Am Fam Physician. 2022; 105 (6): p.640-649.
  12. Agbayani CJG, Fortier MA, Kain ZN. Non-pharmacological methods of reducing perioperative anxiety in children. BJA Education. 2020; 20 (12): p.424-430.doi: 10.1016/j.bjae.2020.08.003 . | Open in Read by QxMD
  13. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2). McGraw-Hill Education / Medical ; 2018
  14. ASA Task Force. Practice Advisory for Preanesthesia Evaluation. Anesthesiology. 2012; 116 (3): p.522-538.doi: 10.1097/aln.0b013e31823c1067 . | Open in Read by QxMD
  15. Pulley DD, Richman DC. Preoperative Evaluation. Anesthesiol Clin. 2016; 34 (1): p.i.doi: 10.1016/s1932-2275(16)00014-8 . | Open in Read by QxMD
  16. Johansson T, Fritsch G, Flamm M, et al. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review. Br J Anaesth. 2013; 110 (6): p.926-939.doi: 10.1093/bja/aet071 . | Open in Read by QxMD
  17. Frank SM, Oleyar MJ, Ness PM, Tobian AAR. Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System. Anesthesiology. 2014; 121 (3): p.501-509.doi: 10.1097/aln.0000000000000338 . | Open in Read by QxMD
  18. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130 (24): p.e278-e333.doi: 10.1161/CIR.0000000000000106 . | Open in Read by QxMD
  19. Stones J, Yates D. Clinical risk assessment tools in anaesthesia. BJA Education. 2019; 19 (2): p.47-53.doi: 10.1016/j.bjae.2018.09.009 . | Open in Read by QxMD
  20. Bernat JL. Patient-Centered Informed Consent in Surgical Practice. Arch Surg. 2006; 141 (1): p.86.doi: 10.1001/archsurg.141.1.86 . | Open in Read by QxMD
  21. McIsaac DI, Abdulla K, Yang H, et al. Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study. Can Med Assoc J. 2017; 189 (27): p.E905-E912.doi: 10.1503/cmaj.160576 . | Open in Read by QxMD
  22. Verbeek DOF, Ponsen KJ, Goslings JC, Heetveld MJ. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop. 2007; 32 (1): p.13-18.doi: 10.1007/s00264-006-0290-9 . | Open in Read by QxMD
  23. Davidson JT, Abelson JS, Glasgow SC, et al. Delaying definitive resection in early stage (I/II) colon cancer appears safe up to 6 weeks. Am J Surg. 2021; 222 (2): p.402-407.doi: 10.1016/j.amjsurg.2020.11.048 . | Open in Read by QxMD
  24. Gray LD, Morris CG. Organisation and planning of anaesthesia for emergency surgery. Anaesthesia. 2012; 68: p.3-13.doi: 10.1111/anae.12054 . | Open in Read by QxMD
  25. Sankar A, Beattie WS, Wijeysundera DN. How can we identify the high-risk patient?. Curr Opin Crit Care. 2015; 21 (4): p.328-335.doi: 10.1097/mcc.0000000000000216 . | Open in Read by QxMD
  26. Wijeysundera DN, Pearse RM, Shulman MA, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. The Lancet. 2018; 391 (10140): p.2631-2640.doi: 10.1016/s0140-6736(18)31131-0 . | Open in Read by QxMD
  27. Lurati Buse GAL, Puelacher C, Gualandro DM, et al. Association between self-reported functional capacity and major adverse cardiac events in patients at elevated risk undergoing noncardiac surgery: a prospective diagnostic cohort study. Br J Anaesth. 2021; 126 (1): p.102-110.doi: 10.1016/j.bja.2020.08.041 . | Open in Read by QxMD
  28. Rubin DS, Huisingh-Scheetz M, Hung A, et al. Accuracy of Physical Function Questions to Predict Moderate-Vigorous Physical Activity as Measured by Hip Accelerometry. Anesthesiology. 2019; 131 (5): p.992-1003.doi: 10.1097/aln.0000000000002911 . | Open in Read by QxMD
  29. Wijeysundera DN, Beattie WS, Hillis GS, et al. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth. 2020; 124 (3): p.261-270.doi: 10.1016/j.bja.2019.11.025 . | Open in Read by QxMD
  30. Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index). Am J Cardiol. 1989; 64 (10): p.651-654.doi: 10.1016/0002-9149(89)90496-7 . | Open in Read by QxMD
  31. Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review.. Anaesthesia. 2009; 64 (8): p.883-93.doi: 10.1111/j.1365-2044.2009.05983.x . | Open in Read by QxMD
  32. Cheng H, Clymer JW, Po-Han Chen B, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018; 229: p.134-144.doi: 10.1016/j.jss.2018.03.022 . | Open in Read by QxMD
  33. Kristensen S, Knuuti J, Saraste A, et. al.. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014; 35 (35): p.2383-2431.doi: 10.1093/eurheartj/ehu282 . | Open in Read by QxMD
  34. Glance LG, Lustik SJ, Hannan EL, et al. The Surgical Mortality Probability Model. Ann Surg. 2012; 255 (4): p.696-702.doi: 10.1097/sla.0b013e31824b45af . | Open in Read by QxMD
  35. Mullen MG, Michaels AD, Mehaffey JH, et al. Risk Associated With Complications and Mortality After Urgent Surgery vs Elective and Emergency Surgery. JAMA Surgery. 2017; 152 (8): p.768.doi: 10.1001/jamasurg.2017.0918 . | Open in Read by QxMD
  36. Wischmeyer PE, Carli F, Evans DC, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia & Analgesia. 2018; 126 (6): p.1883-1895.doi: 10.1213/ane.0000000000002743 . | Open in Read by QxMD
  37. West MA, Wischmeyer PE, Grocott MPW. Prehabilitation and Nutritional Support to Improve Perioperative Outcomes. Current Anesthesiology Reports. 2017; 7 (4): p.340-349.doi: 10.1007/s40140-017-0245-2 . | Open in Read by QxMD
  38. Naseer M, Forssell H, Fagerström C. Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study. Eur J Clin Nutr. 2015; 70 (3): p.399-404.doi: 10.1038/ejcn.2015.196 . | Open in Read by QxMD
  39. Bohl DD, Shen MR, Mayo BC, et al. Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion. Spine. 2016; 41 (21): p.1693-1699.doi: 10.1097/brs.0000000000001591 . | Open in Read by QxMD
  40. Kamath AF, McAuliffe CL, Kosseim LM, Pio F, Hume E. Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission.. The archives of bone and joint surgery. 2016; 4 (2): p.128-31.
  41. O’Leary JG, Yachimski PS, Friedman LS. Surgery in the Patient with Liver Disease. Clin Liver Dis. 2009; 13 (2): p.211-231.doi: 10.1016/j.cld.2009.02.002 . | Open in Read by QxMD
  42. Northup PG, Friedman LS, Kamath PS. AGA Clinical Practice Update on Surgical Risk Assessment and Perioperative Management in Cirrhosis: Expert Review. Clinical Gastroenterology and Hepatology. 2019; 17 (4): p.595-606.doi: 10.1016/j.cgh.2018.09.043 . | Open in Read by QxMD
  43. Liem TK, Huynh TM, Moseley SE, et al. Symptomatic perioperative venous thromboembolism is a frequent complication in patients with a history of deep vein thrombosis. Journal of Vascular Surgery. 2010; 52 (3): p.651-657.doi: 10.1016/j.jvs.2010.04.029 . | Open in Read by QxMD
  44. Lin Y. Preoperative anemia-screening clinics. Hematology. 2019; 2019 (1): p.570-576.doi: 10.1182/hematology.2019000061 . | Open in Read by QxMD
  45. Warner MA, Shore-Lesserson L, Shander A, Patel SY, Perelman SI, Guinn NR. Perioperative Anemia. Anesthesia & Analgesia. 2020; 130 (5): p.1364-1380.doi: 10.1213/ane.0000000000004727 . | Open in Read by QxMD
  46. Howard J, Malfroy M, Llewelyn C, et al. The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS) study: a randomised, controlled, multicentre clinical trial. The Lancet. 2013; 381 (9870): p.930-938.doi: 10.1016/s0140-6736(12)61726-7 . | Open in Read by QxMD
  47. Firth PG, Head CA, Warltier DC. Sickle Cell Disease and Anesthesia. Anesthesiology. 2004; 101 (3): p.766-785.doi: 10.1097/00000542-200409000-00027 . | Open in Read by QxMD
  48. Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R. Preoperative A1C and Clinical Outcomes in Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures. Diabetes Care. 2013; 37 (3): p.611-616.doi: 10.2337/dc13-1929 . | Open in Read by QxMD
  49. Jørgensen ME, Torp-Pedersen C, Gislason GH, et al. Time Elapsed After Ischemic Stroke and Risk of Adverse Cardiovascular Events and Mortality Following Elective Noncardiac Surgery. JAMA. 2014; 312 (3): p.269.doi: 10.1001/jama.2014.8165 . | Open in Read by QxMD
  50. Benesch C, Glance LG, Derdeyn CP, et al. Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association. Circulation. 2021; 143 (19).doi: 10.1161/cir.0000000000000968 . | Open in Read by QxMD
  51. Sherman JB, Chatterjee A, Urman RD, et al. Implementation of Routine Cognitive Screening in the Preoperative Assessment Clinic. A & A Practice. 2019; 12 (4): p.125-127.doi: 10.1213/xaa.0000000000000891 . | Open in Read by QxMD
  52. Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M. Preoperative Cognitive Dysfunction Is Related to Adverse Postoperative Outcomes in the Elderly. J Am Coll Surg. 2012; 215 (1): p.12-17.doi: 10.1016/j.jamcollsurg.2012.02.007 . | Open in Read by QxMD
  53. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Updated: January 1, 2012. Accessed: September 19, 2020.
  54. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Updated: January 1, 2013. Accessed: July 18, 2021.
  55. Bahrainwala JZ, Gelfand SL, Shah A, Abramovitz B, Hoffman B, Leonberg-Yoo AK. Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD. Am J Kidney Dis. 2020; 75 (2): p.245-255.doi: 10.1053/j.ajkd.2019.07.008 . | Open in Read by QxMD
  56. Fielding-Singh V, Vanneman MW, Grogan T, et al. Association Between Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease. JAMA. 2022; 328 (18): p.1837.doi: 10.1001/jama.2022.19626 . | Open in Read by QxMD
  57. Lew SQ, Collins A. When end‐stage kidney disease complicates abdominal surgery. Semin Dial. 2020; 33 (3): p.270-278.doi: 10.1111/sdi.12872 . | Open in Read by QxMD
  58. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO Clinical Practice Guideline for Anemia in CKD 2012. Kidney International Supplements. 2012; 2 (4): p.283-287.doi: 10.1038/kisup.2012.41 . | Open in Read by QxMD
  59. Woo SH, Zavodnick J, Ackermann L, Maarouf OH, Zhang J, Cowan SW. Development and Validation of a Web-Based Prediction Model for AKI after Surgery. Kidney360. 2020; 2 (2): p.215-223.doi: 10.34067/kid.0004732020 . | Open in Read by QxMD
  60. Renfan Xu, Anyu Tao, Yang Bai, Youbin Deng, Guangzhi Chen. Effectiveness of Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2016; 5 (9).doi: 10.1161/jaha.116.003968 . | Open in Read by QxMD
  61. Ostermann M, Bellomo R, Burdmann EA, et al. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney Int. 2020; 98 (2): p.294-309.doi: 10.1016/j.kint.2020.04.020 . | Open in Read by QxMD
  62. McDonald RJ, McDonald JS, Carter RE, et al. Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality. Radiology. 2014; 273 (3): p.714-725.doi: 10.1148/radiol.14132418 . | Open in Read by QxMD
  63. Zisa D, Goodman SM. Perioperative Management of Rheumatic Disease and Therapies. Med Clin North Am. 2021; 105 (2): p.273-284.doi: 10.1016/j.mcna.2020.09.011 . | Open in Read by QxMD
  64. Colebatch AN, Edwards CJ, Østergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013; 72 (6): p.804-814.doi: 10.1136/annrheumdis-2012-203158 . | Open in Read by QxMD
  65. Goodman SM, Springer BD, Chen AF, et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care Res. 2022; 74 (9): p.1399-1408.doi: 10.1002/acr.24893 . | Open in Read by QxMD
  66. Greenhill LL, Pliszka S, Dulcan MK. Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents, and Adults. J Am Acad Child Adolesc Psychiatry. 2002; 41 (2): p.26S-49S.doi: 10.1097/00004583-200202001-00003 . | Open in Read by QxMD
  67. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome.. Br J Anaesth. 1996; 77 (2): p.217-22.doi: 10.1093/bja/77.2.217 . | Open in Read by QxMD
  68. Hurwitz EE, Simon M, Vinta SR, et al. Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients. Anesthesiology. 2017; 126 (4): p.614-622.doi: 10.1097/aln.0000000000001541 . | Open in Read by QxMD
  69. Hackett NJ, De Oliveira GS, Jain UK, Kim JYS. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surgery. 2015; 18: p.184-190.doi: 10.1016/j.ijsu.2015.04.079 . | Open in Read by QxMD
  70. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation. 1999; 100 (10): p.1043-1049.doi: 10.1161/01.cir.100.10.1043 . | Open in Read by QxMD
  71. Raslau D, Bierle DM, Stephenson CR, Mikhail MA, Kebede EB, Mauck KF. Preoperative Cardiac Risk Assessment. Mayo Clinic Proceedings. 2020; 95 (5): p.1064-1079.doi: 10.1016/j.mayocp.2019.08.013 . | Open in Read by QxMD
  72. Bilimoria KY, Liu Y, Paruch JL, et al. Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator: A Decision Aid and Informed Consent Tool for Patients and Surgeons. J Am Coll Surg. 2013; 217 (5): p.833-842.e3.doi: 10.1016/j.jamcollsurg.2013.07.385 . | Open in Read by QxMD
  73. Gupta PK, Gupta H, Sundaram A, et al. Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery. Circulation. 2011; 124 (4): p.381-387.doi: 10.1161/circulationaha.110.015701 . | Open in Read by QxMD
  74. Roshanov PS, Rochwerg B, Patel A, et al. Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery. Anesthesiology. 2017; 126 (1): p.16-27.doi: 10.1097/aln.0000000000001404 . | Open in Read by QxMD
  75. Hornor MA, Duane TM, Ehlers AP, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. J Am Coll Surg. 2018; 227 (5): p.521-536.e1.doi: 10.1016/j.jamcollsurg.2018.08.183 . | Open in Read by QxMD
  76. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative Management of Antithrombotic Therapy. Chest. 2012; 141 (2): p.e326S-e350S.doi: 10.1378/chest.11-2298 . | Open in Read by QxMD
  77. Doherty JU et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation. J Am Coll Cardiol. 2017; 69 (7): p.871-898.doi: 10.1016/j.jacc.2016.11.024 . | Open in Read by QxMD
  78. Pfeifer KJ, Selzer A, Mendez CE, et al. Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clinic Proceedings. 2021; 96 (6): p.1655-1669.doi: 10.1016/j.mayocp.2020.10.002 . | Open in Read by QxMD
  79. Sadana N, Joshi GP. Pharmacology and Perioperative Considerations for Psychiatric Medications. Curr Clin Pharmacol. 2018; 12 (3): p.169-175.doi: 10.2174/1574884712666170823121850 . | Open in Read by QxMD
  80. Zimbrean PC, Oldham MA, Lee HB. Perioperative Psychiatry. Springer ; 2018
  81. Younan M, Atkinson T, Fudin J. A practical approach to discontinuing NSAID therapy prior to a procedure. Pract Pain Manag. 2013; 13 (10): p.45-51.
  82. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions.. Am Fam Physician. 2009; 80 (12): p.1371-8.
  83. Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care & Research. 2017; 69 (8): p.1111-1124.doi: 10.1002/acr.23274 . | Open in Read by QxMD
  84. Ang-Lee MK. Herbal Medicines and Perioperative Care. JAMA. 2001; 286 (2): p.208.doi: 10.1001/jama.286.2.208 . | Open in Read by QxMD
  85. Wong J, An D, Urman RD, et al. Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation. Anesthesia & Analgesia. 2019; 131 (3): p.955-968.doi: 10.1213/ane.0000000000004508 . | Open in Read by QxMD
  86. Pierre S, Rivera C, Le Maître B, et al. Guidelines on smoking management during the perioperative period. Anaesthesia Critical Care & Pain Medicine. 2017; 36 (3): p.195-200.doi: 10.1016/j.accpm.2017.02.002 . | Open in Read by QxMD
  87. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009; 102 (3): p.297-306.doi: 10.1093/bja/aen401 . | Open in Read by QxMD
  88. T⊘nnesen H, Rosenberg J, Nielsen HJ, et al. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ. 1999; 318 (7194): p.1311-1316.doi: 10.1136/bmj.318.7194.1311 . | Open in Read by QxMD
  89. Ungur AL, Neumann T, Borchers F, Spies C. Perioperative Management of Alcohol Withdrawal Syndrome. Visceral Medicine. 2020; 36 (3): p.160-166.doi: 10.1159/000507595 . | Open in Read by QxMD
  90. Jesse S, Bråthen G, Ferrara M, et al. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol Scand. 2016; 135 (1): p.4-16.doi: 10.1111/ane.12671 . | Open in Read by QxMD
  91. Faithfull S, Turner L, Poole K, et al. Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes. Eur J Cancer Care (Engl). 2019; 28 (4).doi: 10.1111/ecc.13023 . | Open in Read by QxMD
  92. Cabilan CJ, Hines S, Munday J. The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI Database Syst Rev Implement Rep. 2015; 13 (1): p.146-187.doi: 10.11124/jbisrir-2015-1885 . | Open in Read by QxMD
  93. ASA Taskforce. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology. 2017; 126 (3): p.376-393.doi: 10.1097/aln.0000000000001452 . | Open in Read by QxMD
  94. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery.. Am J Health Syst Pharm. 2013; 70 (3): p.195-283.doi: 10.2146/ajhp120568 . | Open in Read by QxMD
  95. Tarchini G, Liau KH, Solomkin JS. Antimicrobial Stewardship in Surgery: Challenges and Opportunities. Clinical Infectious Diseases. 2017; 64 (suppl_2): p.S112-S114.doi: 10.1093/cid/cix087 . | Open in Read by QxMD
  96. Smilowitz NR, Berger JS. Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery. JAMA. 2020; 324 (3): p.279.doi: 10.1001/jama.2020.7840 . | Open in Read by QxMD
  97. Duceppe E, Parlow J, MacDonald P, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017; 33 (1): p.17-32.doi: 10.1016/j.cjca.2016.09.008 . | Open in Read by QxMD
  98. Duceppe E, Patel A, Chan MTV, et al. Preoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery. Ann Intern Med. 2019; 172 (2): p.96.doi: 10.7326/m19-2501 . | Open in Read by QxMD
  99. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Thorac Cardiovasc Surg. 2016; 152 (5): p.1243-1275.doi: 10.1016/j.jtcvs.2016.07.044 . | Open in Read by QxMD
  100. Vetter TR, Short RT, Hawn MT, Marques MB. Perioperative Management of the Patient with a Coronary Artery Stent. Anesthesiology. 2014; 121 (5): p.1093-1098.doi: 10.1097/aln.0000000000000451 . | Open in Read by QxMD
  101. ASA Taskforce. Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter–Defibrillators 2020. Anesthesiology. 2020; 132 (2): p.225-252.doi: 10.1097/aln.0000000000002821 . | Open in Read by QxMD
  102. Crossley GH, Poole JE, Rozner MA, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the Perioperative Management of Patients with Implantable Defibrillators, Pacemakers and Arrhythmia Monitors: Facilities and Patient Management: Executive Summary. Heart Rhythm. 2011; 8 (7): p.e1-e18.doi: 10.1016/j.hrthm.2011.05.010 . | Open in Read by QxMD
  103. Falk V, Baumgartner H, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardio-Thorac Surg. 2017; 52 (4): p.616-664.doi: 10.1093/ejcts/ezx324 . | Open in Read by QxMD
  104. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Siewert M, Pandit UA. Risk Factors for Perioperative Adverse Respiratory Events in Children with Upper Respiratory Tract Infections. Anesthesiology. 2001; 95 (2): p.299-306.doi: 10.1097/00000542-200108000-00008 . | Open in Read by QxMD
  105. Canet J, Gallart L, Gomar C, et al. Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort. Anesthesiology. 2010; 113 (6): p.1338-1350.doi: 10.1097/aln.0b013e3181fc6e0a . | Open in Read by QxMD
  106. Gross JB et al. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology. 2006; 104 (5): p.1081-1093.doi: 10.1097/00000542-200605000-00026 . | Open in Read by QxMD
  107. Costescu F, Slinger P. Preoperative Pulmonary Evaluation. Current Anesthesiology Reports. 2018; 8 (1): p.52-58.doi: 10.1007/s40140-018-0252-y . | Open in Read by QxMD
  108. Bernstein WK, Deshpande S. Preoperative evaluation for thoracic surgery. Semin Cardiothorac Vasc Anesth. 2008; 12 (2): p.109-121.doi: 10.1177/1089253208319868 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer