Preoperative evaluation of patients: a review

Patients undergoing surgery move through a continuum of medical care to which a primary care physician, an internist, an anaesthesiologist, and a surgeon contribute to ensure the best outcome possible. No aspect of medicine requires greater cooperation than the performance of surgery and the perioperative care of a patient. For the anaesthesiologist, this responsibility should start in a preoperative clinic. The importance of integrating practice is even greater because of the increasing life span of our population. As the number of elderly patients increases, so does the need for preoperative consultation to plan for comorbidities and multiple drug regimens, knowledge of which is crucial to successful patient management. At a time when medical information is encyclopaedic, it is difficult for even the most conscientious anaesthesiologist or surgeon to keep abreast of medical issues relevant to perioperative patient management. Thus, a proposed preoperative assessment clinic facilitates those most sought-after goals, increased quality and reduced costs. As part of this process, ordering only laboratory tests warranted by a patient's symptoms and medical history is important to avoid risks of unnecessary testing and of follow-up of false-positive results.