Preoperative Evaluation: Pulmonary, Cardiac, Renal Dysfunction and Comorbidities

As physicians and surgeons, we are interested in improving our patients’ general well-being. When we recommend a surgical procedure, we expect a good outcome. Stated differently, we recommend invasive procedures and operations to our patients when we have a reasonable expectation that, by excising a tumor, removing the source of inflammation or infection, or by performing a reconstructive procedure to improve organ-system function or the patient’s functional status, we will improve the patient’s overall condition. We also recommend surgery when we know that the benefits of the operation or intervention far outweigh the associated risk of the procedure. Additionally, to ensure the best possible result and outcome, we are interested in minimizing complications that are known to occur with a given procedure. Our knowledge and experience help us select those patients who are best suited for an operation or who will likely have the best result and outcome. The process of selecting the best candidates for an operation has many facets, including an initial patient assessment and identification of patient characteristics that affect outcome. This selection process is an exercise in risk assessment. Often, by optimizing the patient’s condition, surgeons can achieve the best possible result and outcome. Furthermore, surgeons may find after this risk assessment that the risks of the procedure outweigh the benefits. Surgeons thus may not recommend an invasive procedure, especially if it is unusually complex and risky.