Preoperative screening and risk assessment in the ambulatory surgery patient

PURPOSE OF REVIEW: With the rapid increase in the number of sicker patients with multiple co-morbidities and extremes of age who are undergoing ambulatory surgery, a thorough and detailed preoperative workup has become increasingly important. Case cancellation on the morning of surgery should be an exception. Therefore, much attention is focused on the optimization of the sicker patients. Although the anesthesiologist plays a central role in the preoperative assessment, a multidisciplinary approach is critical. This review was done to provide the reader with current trends and practices in preoperative assessment of the ambulatory surgical patient. RECENT FINDINGS: The risk factors that may influence major morbidity, death or hospital admission include age greater than 85 years, hospital admission within the previous 6 months and invasiveness of surgery. The American Society of Anesthesiologists' physical status greater than 2 can predict in-hospital adverse events. Routine preoperative investigations in the healthy patient, including electrocardiogram are, today, unwarranted and have not been shown to improve outcome. SUMMARY: Risk management involves the identification of the patient at risk, optimization of preoperative health status, risk reduction through medical intervention as well as appropriate perioperative care. Thus, patient outcome can be improved, specifically for the sicker patients at a higher risk.