Preoperative Risk Stratification for Major Events

The preoperative assessment of surgical patients, including colorectal patients, has undergone significant changes over the last 20 years. The rationale for such changes is based on evidence-based guidelines that showed a minimal clinical impact from broad base testing in healthy patients. Additionally, nonselective testing has been shown to be a large economic burden to the American health care system. As such, a tailored approach based on risk stratification is recommended rather than a "standard, one-size-fits-all" approach. This article will review current risk stratification and preoperative evaluation strategies for patients undergoing elective colorectal surgery. Emphasis will be given to areas in which preoperative optimization strategies may be employed to minimize operative risks. We will review the role and need of preoperative testing in specific patient populations and highlight situations where preoperative evaluation impacts operative timing and planning. Specifically, emphasis will be placed on strategies for mitigation of major adverse cardiac events. The aim is to provide a framework that allows for safe and responsible preoperative assessment.