[Responsibility of the anaesthesiologist in the preoperative risk evaluation]

Correct indications are essential to perform surgical procedures. However, appropriate timing to achieve minimal rates of complications even in high-risk patients or major surgery is at the top of the priority list. Perioperative responsibility is divided between anaesthesiologists and surgeons. While the surgeon is accountable for the surgical procedure, the anaesthesiologist is responsible for preoperative risk evaluation, perioperative management, and maintenance of vital organ functions. Both of these medical specialities must weigh the urgency of the procedure against patient-associated risk factors. Goals are optimal patient safety, efficient preoperative evaluation and subsequent optimisation to reduce the burden for the health care systems. For most patients without underlying diseases, a thorough history and physical examination is sufficient. In teaching hospitals, some laboratory results for screening of organ function are advisable. Patients can be stratified on clinical grounds into low-, medium-, and high-risk categories. Use of these categories, along with consideration of the type and urgency of surgery, allows for a reasonable approach to preoperative testing. Testing directed towards assessment of organ system functional reserve and identification of organs at risk rather than the diagnosis of a specific disease, is the primary goal of preoperative evaluation prior to surgery. These results are essential to prepare an effective anaesthetic plan. Along with increased patient comfort, the number of preoperative hospital days can be reduced by outpatient preoperative evaluation clinics.