Contemporary preoperative assessment for colorectal surgery: new insights and developments

Preoperative assessment is a critical step for every patient undergoing major colorectal surgery. Increasingly, major colorectal resection is being safely performed in older and multimorbid patients. Many established tenets of preoperative assessment-careful history and examination and selected laboratory investigations-have remained unchanged for decades. However, there is an increasing focus on the importance of this step in the pathway as a key opportunity to intervene and improve patient outcomes following surgery. Patients are increasingly complex, necessitating a multidisciplinary approach involving a range of specialists to help identify and optimise modifiable risk factors and manage comorbidities. Modern approaches use risk stratification scores to better communicate risk, nutritional and frailty assessments, intravenous iron therapy, antibiotic plus bowel cleansing regimens and the use of biomarkers. Preoperative patient education and prehabilitation approaches are being harnessed to better prepare patients for surgery. Comprehensive assessment and optimisation before surgery can improve surgical outcomes and contribute to safer perioperative care.