Preoperative assessment. Primary care work-up to identify surgical risks.

For many older patients, surgery is an inevitable component of healthcare. Thorough and effective preoperative patient evaluation is imperative because comorbidities, polypharmacy, functional problems, and socio-economic issues all can affect perioperative decisions and complicate recovery. A methodical assessment includes a history and physical exam, review of prescription and nonprescription medications, evaluation of major organ systems, and discussion with the patient of advance directives. Other major considerations include functional status, the risk level of the surgery to be performed, expected blood loss, and anesthesia duration. The primary care physician must synthesize and relay this patient data to the surgical team so that appropriate measures can be taken to minimize perioperative risks and promote uncomplicated recovery.