Perioperative Risk Assessment

While no surgery can be completely risk-free, a thorough preoperative evaluation serves to identify and control perioperative risk as much as possible. Major advances in surgery and anesthesia and improvements in preoperative risk assessment and management have led to a dramatic decrease in perioperative morbidity and mortality. This, in turn, has expanded the eligible patient population for major surgical procedures to include patients who would not have been considered surgical candidates in the past. Perioperative risk assessment has three fundamental goals: (1) to identify previously undetected comorbid conditions or factors, (2) to evaluate known conditions or factors that may increase the risk of perioperative complications, and (3) to optimize medical conditions preoperatively to reduce perioperative risk. Perioperative risk can be classified into three categories: patient-specific risk, procedure-specific risk, and anesthetic-specific risk. Although these categories exist as distinct concepts, in practical terms, they are not independent and must be considered in concert when patients are being evaluated for surgery.