Preoperative Evaluation: A Clinical Guide for Patients and Clinicians

A preoperative evaluation determines whether you are medically ready for a planned procedure and identifies specific, evidence-based steps to reduce your risk before, during, and after surgery. For elective cases, the evaluation should begin well in advance before the scheduled date to allow time to optimize chronic conditions, adjust medications, and complete targeted testing. For urgent cases, the same core assessment applies, but the timeline compresses to hours rather than weeks, and the focus shifts to stabilizing the most critical risks first.

If you are preparing for surgery, your first step is to contact your primary care provider to schedule a preoperative visit, gather your current medication list (including supplements), and bring records of any recent hospitalizations, cardiac testing, or specialist visits. Your clinician will then guide you through the components covered in this guide:

• Focused history and physical examination
• Targeted laboratory and diagnostic testing
• Cardiac and pulmonary risk assessment
• Formal risk estimation using validated calculators
• Medication management and perioperative adjustments
• Optimization and prehabilitation strategies
• Anesthesia coordination and shared decision-making

Key Takeaways

A preoperative evaluation is most effective when it combines targeted testing, validated risk estimation, and active optimization sufficiently before the day of surgery.

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

Table of Contents

• What does a preoperative evaluation include?
• Which preoperative tests are actually necessary?
• How do you assess cardiac risk before surgery?
• Who is at risk for pulmonary complications after surgery?
• How do you use risk calculators to estimate surgical risk?
• How should you manage medications before surgery?
• What is prehabilitation and how does it improve surgical outcomes?
• How does the preanesthesia evaluation fit into the process?
• Special considerations for elderly, frail, and urgent surgical patients
• Who performs the evaluation and when should it happen?
• What should clinicians and patients do next?
• Where to find authoritative calculators and guidelines
• Garden State Medical Group's approach to preoperative preparation
• Coordinated preoperative care at Garden State Medical Group
• Sources
• FAQ

What does a preoperative evaluation include?

The foundation of any preoperative assessment is a focused history and physical examination. According to UpToDate's clinical review, the evaluation should include a review of medical records, a comprehensive medical history, and a cardiovascular and pulmonary physical exam, with medication reconciliation and written, individualized medication instructions as essential components.

History items that actually change management

The history is not a formality. These are the items that most directly affect perioperative planning:

• Surgical indication and urgency: Elective, urgent, or emergent status determines how much time is available for optimization.
• Cardiovascular symptoms: Chest pain, dyspnea, palpitations, syncope, or prior myocardial infarction, stent, or valve disease.
• Pulmonary symptoms: Chronic cough, wheezing, recent respiratory infection, known obstructive sleep apnea (OSA), or home oxygen use.
• Bleeding history: Easy bruising, prolonged bleeding after prior procedures, family history of bleeding disorders, or current anticoagulation.
• Medications and supplements: Every prescription drug, over-the-counter medication, and herbal supplement, since several increase bleeding risk or interact with anesthetics.
• Recent hospitalizations or infections: Within the past 30–90 days, these can signal unresolved illness or increased infection risk.
• Functional capacity: How much physical activity can you do without stopping? This is measured in metabolic equivalents (METs).
• Cognitive status and social supports: Particularly relevant for elderly patients, since cognitive impairment affects consent, delirium risk, and discharge planning.

Focused physical exam priorities

The exam should target findings that will prompt a change in management. Airway assessment (Mallampati class, neck mobility, mouth opening) goes directly to anesthesia planning. Cardiovascular exam looks for murmurs, irregular rhythm, signs of heart failure, or diminished peripheral pulses. Pulmonary exam checks oxygen saturation at rest, breath sounds, and any wheeze or crackle that suggests active disease. Volume status, skin integrity, and signs of malnutrition round out the picture for high-risk patients.

Pro Tip: To assess functional capacity quickly in the office, ask: "Can you walk up a flight of stairs or walk on level ground at 4 mph without stopping?" A yes suggests at least 4 METs of capacity, which is the threshold below which cardiac testing decisions become more complex. If the answer is no, follow up with the Duke Activity Status Index (DASI) questionnaire for a more precise estimate.

For patients preparing for a primary care preoperative visit, knowing what to bring and what to expect can make the appointment more productive for both you and your clinician.

When to escalate to an in-person preop clinic rather than telephone screening: any patient with known or suspected cardiac disease, poorly controlled diabetes or hypertension, a complex medication regimen, or a planned intermediate- to high-risk procedure should be seen in person before the day of surgery.

Which preoperative tests are actually necessary?

The guiding principle is straightforward: routine preoperative testing for low-risk procedures is not recommended. Testing should be ordered only when the result will change perioperative management. Ordering a panel of labs and an ECG for a healthy 35-year-old having an inguinal hernia repair does not reduce adverse events. It does, however, trigger cascades of additional workup that can delay or cancel surgery without improving outcomes.

A practical note on timing: most institutions accept laboratory results within 30 days of surgery for stable patients, and ECGs within 90 days if there has been no interval cardiac event. Results should be reviewed by the ordering clinician before the day of surgery, not on the morning of the procedure.

How do you assess cardiac risk before surgery?

Cardiac complications are among the most serious perioperative events, and a structured approach to cardiac risk assessment is one of the highest-value components of the preoperative process.

ASA Physical Status Classification

The American Society of Anesthesiologists (ASA) Physical Status Classification assigns patients to one of six classes based on systemic disease severity, from ASA I (normal healthy patient) to ASA VI (brain-dead organ donor). ASA class correlates with perioperative mortality and guides anesthesia planning, though it is a broad descriptor rather than a precise risk calculator.

Revised Cardiac Risk Index (RCRI)

The Revised Cardiac Risk Index is the most widely used bedside tool for estimating major adverse cardiac event (MACE) risk before noncardiac surgery. It assigns one point for each of the following:

• High-risk surgery (intrathoracic, intraperitoneal, or suprainguinal vascular)
• History of ischemic heart disease
• History of congestive heart failure
• History of cerebrovascular disease
• Insulin-dependent diabetes
• Preoperative creatinine above 2.0 mg/dL

An RCRI score of 0–1 indicates low cardiac risk. Higher scores indicate increasing risk where further evaluation or optimization is warranted.

Functional capacity and the testing decision

Functional capacity, measured in METs, is central to the cardiac evaluation algorithm. Patients who can achieve 4 or more METs without cardiac symptoms (climbing stairs, brisk walking, light housework) generally do not need additional cardiac testing before intermediate-risk surgery, regardless of RCRI score. When functional capacity is poor or unknown and the RCRI score is elevated, the question becomes whether stress testing or echocardiography will change management. The answer should drive the decision, not a reflexive order.

The algorithmic path looks like this: first, determine whether the surgery is emergent (proceed with risk documentation). For elective cases, identify active cardiac conditions (unstable angina, decompensated heart failure, severe valvular disease, significant arrhythmia) that require treatment before any elective procedure. If none are present, estimate surgical risk using RCRI and procedure type, then assess functional capacity. If capacity is adequate, proceed. If capacity is poor or unknown and the patient has elevated RCRI, consider pharmacologic stress testing only if the result will change management (alter the surgical plan, lead to revascularization, or guide anesthetic technique).

Perioperative myocardial injury (PMI) occurs more commonly than clinically recognized, and many events are detected only through routine troponin surveillance in high-risk patients rather than through symptoms. This underscores why a focused cardiac assessment before surgery is worth doing carefully, not as a checkbox.

Who is at risk for pulmonary complications after surgery?

Postoperative pulmonary complications, including pneumonia, respiratory failure, and prolonged mechanical ventilation, are a leading cause of perioperative morbidity. Identifying patients at elevated risk before surgery allows time for meaningful intervention.

Key pulmonary risk factors include:

• Age above 65
• Known COPD or asthma with poor control
• Obstructive sleep apnea (OSA), particularly untreated
• Current smoking
• Recent respiratory infection (within four weeks of surgery)
• Heart failure with reduced ejection fraction
• Planned thoracic or upper abdominal surgery
• Prolonged operative time (greater than three hours)
• General anesthesia versus regional or neuraxial

Clinical findings predict postoperative pulmonary complications more reliably than routine pulmonary function tests (PFTs). Targeted pulmonary risk assessment identifies patients who will benefit from intervention; routine PFTs are not recommended for most non-thoracic surgical patients. The ARISCAT score is one validated tool for estimating pulmonary complication risk when the clinical picture suggests concern.

When chest imaging is indicated: order a chest X-ray when there is new or unexplained dyspnea, suspected heart failure, or a planned thoracic procedure. Routine chest X-rays for asymptomatic patients under 70 without cardiopulmonary disease add little to management.

Mitigation steps that genuinely reduce risk include optimizing inhaler therapy for COPD or asthma patients before surgery, treating active respiratory infections and postponing elective procedures until resolution, and referring OSA patients for CPAP initiation or compliance verification.

Pro Tip: Smoking cessation at least four to eight weeks before elective surgery reduces pulmonary complication risk. Cessation within two weeks of surgery may temporarily increase secretions, so earlier is better. When counseling patients, frame it as a concrete, time-bound goal tied to their surgery date rather than a general health recommendation. Nicotine replacement therapy and varenicline are both appropriate options to discuss.

How do you use risk calculators to estimate surgical risk?

Validated risk calculators translate a patient's clinical profile into a specific, numeric probability of postoperative complications. The ACS NSQIP Surgical Risk Calculator is the most widely used tool in the United States for this purpose. It estimates patient-specific probabilities of postoperative complications using 21 preoperative factors and is designed to support patient counseling and shared decision-making.

How the ACS NSQIP calculator works

The calculator asks for procedure type (by CPT code), patient demographics, and clinical variables including ASA class, functional status, diabetes status, smoking history, dyspnea, heart failure, hypertension, steroid use, bleeding disorders, and recent weight loss, among others. The output is a set of individualized risk estimates for outcomes such as serious complication, any complication, pneumonia, cardiac event, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to the operating room, discharge to a care facility, and 30-day mortality.

A practical workflow for using the calculator:

• Gather the patient's CPT code from the surgical team before the preoperative visit.
• Enter clinical variables from the history and physical.
• Review the output with the patient, framing absolute risk (e.g., "your estimated risk of a serious complication is 4 in 100") rather than relative comparisons.
• Document the risk estimate and the discussion in the medical record.

The universal ACS NSQIP model also includes a Surgeon Adjustment Score, which allows clinicians to raise or lower the model's estimate within its confidence interval when clinical judgment suggests the model does not fully capture the patient's situation. This is particularly useful for patients with unusual comorbidity combinations or when the surgical team has specific technical concerns.

Limitations worth knowing: the calculator performs best for procedures and patient profiles well-represented in the NSQIP database. It is less reliable for very rare procedures, pediatric patients, or highly specialized surgical populations. Multiple organ-system risk indices for pulmonary, renal, hematologic, and surgical site infection risk are available as supplements when the clinical exam suggests organ-specific concern.

For shared decision-making, visual aids such as icon arrays (showing risk as colored figures out of 100) can help patients understand numeric probabilities more intuitively than percentages alone. Document that the discussion occurred, what risk estimates were shared, and that the patient understood and consented.

How should you manage medications before surgery?

Medication reconciliation is one of the highest-yield safety steps in the preoperative process. Errors in this step, including continuing medications that should be paused or stopping medications that should continue, contribute directly to perioperative complications. Preoperative medication reconciliation, including prescription drugs and supplements, is essential, and written, individualized instructions should be provided to every patient.

Common medication classes and practical perioperative guidance:

• Anticoagulants (warfarin, direct oral anticoagulants): Typically held before surgery based on bleeding risk and half-life. Warfarin is usually held five days before; DOACs (apixaban, rivaroxaban) are held one to two days for low-risk procedures and two to four days for high-risk procedures. Bridging with heparin is reserved for patients with the highest thrombotic risk (mechanical heart valves, recent VTE). Coordinate with the anticoagulation clinic or prescribing cardiologist.
• Antiplatelet agents (aspirin, clopidogrel): Aspirin for primary prevention is generally held seven to ten days before surgery. Aspirin for secondary prevention (prior MI, stent) is often continued. Clopidogrel is typically held five to seven days before procedures with significant bleeding risk. Decisions for patients with recent coronary stents require cardiology input.
• Insulin and oral hypoglycemics: Long-acting insulin doses are typically adjusted before surgery under clinical guidance to avoid hypoglycemia. Short-acting insulin is held the morning of surgery. Metformin is held the day of surgery and for 48 hours after procedures using iodinated contrast. SGLT-2 inhibitors (empagliflozin, dapagliflozin) should be held three to four days before surgery due to risk of euglycemic diabetic ketoacidosis.
• ACE inhibitors and ARBs: Current guidance generally supports holding ACEi/ARBs the morning of surgery for most patients to reduce the risk of intraoperative hypotension, particularly with general anesthesia. Resume postoperatively when the patient is hemodynamically stable and tolerating oral intake.
• Beta-blockers: Continue in patients already taking them. Do not initiate beta-blockers acutely within 24 hours of surgery solely to reduce cardiac risk, as this increases stroke risk.

Supplements and over-the-counter medications

Several common supplements increase bleeding risk and should be stopped at least seven to ten days before surgery: fish oil, vitamin E at high doses, garlic supplements, ginkgo biloba, ginseng, and St. John's Wort. NSAIDs (ibuprofen, naproxen) should be held five to seven days before procedures with significant bleeding risk.

Pro Tip: Coordinate all medication changes through the patient's primary care provider, cardiologist, or anticoagulation clinic rather than making unilateral changes at the preoperative visit. Provide written instructions that list each medication, the last dose to take, and when to resume. Patients who receive verbal-only instructions frequently make errors.

What is prehabilitation and how does it improve surgical outcomes?

The modern goal of preoperative evaluation is not simply to clear a patient for surgery. It is to actively optimize that patient's condition so they enter the operating room in the best possible state. This shift from clearance to optimization is what prehabilitation means in practice.

Anesthesiology-directed preoperative clinics and prehabilitation strategies for intermediate- and high-risk patients are associated with improved outcomes, including more days alive at home and reduced length of stay in some studies. The evidence is clearest for patients with modifiable risk factors who have adequate lead time before elective surgery.

Key optimization interventions with recommended timing:

• Smoking cessation: Four to eight weeks before surgery for pulmonary benefit; longer cessation improves wound healing and immune function.
• Glycemic control: Target HbA1c below 8% before elective surgery when feasible. Poorly controlled diabetes increases surgical site infection risk and impairs wound healing. For patients who need support, a structured diabetes education program can help establish better glucose management in the weeks before a procedure.
• Anemia management: Iron deficiency anemia should be treated with oral or intravenous iron supplementation four to eight weeks before surgery when possible. Correcting preoperative anemia reduces transfusion requirements and improves recovery.
• Structured exercise: Even a four-week program of moderate aerobic and resistance exercise improves functional capacity and reduces postoperative fatigue. Patients with very low baseline fitness benefit most.
• Nutritional optimization: Patients with BMI below 18.5 or significant unintentional weight loss should receive nutritional assessment and supplementation before elective procedures. Malnutrition increases infection risk and delays healing.
• Vaccination and preventive care: Pneumococcal and influenza vaccines should be current before elective surgery, particularly for patients with chronic lung or heart disease.

Primary care clinicians play a central role in coordinating prehabilitation, particularly for patients managing multiple chronic conditions. Ensuring that blood pressure, blood glucose, and heart failure are well-controlled before surgery reduces last-minute cancellations and improves outcomes. Practical guidance on managing chronic conditions before a procedure can help patients take concrete steps in the weeks leading up to surgery.

How does the preanesthesia evaluation fit into the process?

The preoperative medical evaluation and the preanesthesia evaluation are related but distinct. The preoperative medical evaluation, typically performed by a primary care provider or internist, focuses on identifying and optimizing medical risk. The preanesthesia evaluation, performed by an anesthesiologist or certified registered nurse anesthetist (CRNA), focuses on airway assessment, anesthetic plan selection, monitoring requirements, and pain management strategy.

What anesthesiologists typically assess during the preanesthesia evaluation:

• Airway: Mallampati class, mouth opening, neck mobility, history of difficult intubation
• Anesthetic plan: general versus regional versus neuraxial, based on procedure and patient factors
• Monitoring needs: arterial line, central venous access, transesophageal echocardiography
• Pain plan: multimodal analgesia, regional nerve blocks, opioid-sparing strategies
• NPO (nothing by mouth) instructions and aspiration risk

Coordination checklist: the anesthesia team needs the completed H&P, current medication list with perioperative instructions, relevant test results (ECG, labs, imaging), specialist consultation notes, and the patient's ASA class and RCRI score documented in the chart before the day of surgery.

Pro Tip: Request an anesthesiology-directed preoperative clinic visit for any patient with an ASA class III or higher, a known or suspected difficult airway, planned major surgery, or significant cardiac or pulmonary comorbidity. Seeing anesthesia before the day of surgery prevents last-minute cancellations and allows time to address concerns that would otherwise delay the case.

Special considerations for elderly, frail, and urgent surgical patients

Geriatric and frailty considerations

Frailty, defined by reduced physiologic reserve across multiple organ systems, is a stronger predictor of postoperative complications and prolonged recovery than chronologic age alone. Frail patients are at higher risk for delirium, falls, functional decline, and discharge to a care facility rather than home. Frailty screening tools such as the Clinical Frailty Scale or the FRAIL questionnaire can be completed quickly in the preoperative setting.

For frail patients, optimization priorities shift: nutritional support, mobility preservation, delirium prevention planning (avoiding high-risk medications, orienting protocols), and realistic goals-of-care discussions become as important as managing individual organ-system risks. Cognitive impairment affects informed consent capacity and requires early involvement of a surrogate decision-maker when needed.

Ambulatory surgery candidates

Patients being considered for outpatient (ambulatory) surgery should meet criteria for safe discharge on the day of procedure: stable comorbidities, adequate home support, no anticipated need for overnight monitoring, and a procedure with low expected blood loss and short recovery. Patients with poorly controlled heart failure, severe OSA without CPAP compliance, or recent cardiac events generally require inpatient planning rather than ambulatory scheduling.

Urgent and emergent cases

When surgery cannot be delayed, the evaluation compresses to the highest-yield items: airway assessment, current medications and anticoagulation status, known cardiac or pulmonary disease, allergy history, and NPO status. Document all unresolved optimization items clearly in the chart so the surgical and anesthesia teams can account for them intraoperatively.

Pro Tip: For emergent cases, use a compact documentation checklist: (1) known allergies confirmed, (2) anticoagulation status and last dose recorded, (3) active cardiac or pulmonary conditions noted, (4) airway risk flagged for anesthesia, (5) informed consent obtained or surrogate identified, (6) unresolved optimization items listed. This takes under five minutes and prevents the most common communication failures in urgent settings.

Who performs the evaluation and when should it happen?

Timing and role clarity prevent the most common preoperative failures: last-minute cancellations, duplicate testing, and medication errors.

Recommended lead times by risk level:

• Low-risk procedure, healthy patient: Telephone or portal-based screening one to two weeks before surgery; in-person visit only if red flags are identified.
• Intermediate-risk procedure or patient with stable comorbidities: In-person preoperative visit two to four weeks before surgery; anesthesia clinic visit if ASA III or complex airway.
• High-risk procedure or patient with significant comorbidities: In-person evaluation four to six weeks before surgery; anesthesiology-directed preop clinic visit; specialist consultation as needed.

Roles and responsibilities in the preoperative process:

The ASA Task Force recommends that preoperative assessment occur before the day of surgery for high-severity patients or high-invasiveness procedures. Completing the evaluation in advance gives time to act on findings rather than simply document them. Results should be accessible to the surgical and anesthesia teams in the EHR before the procedure date, not faxed the morning of surgery.

A practical note: the step-by-step primary care visit guide can help patients understand what to expect at their preoperative appointment and arrive prepared.

What should clinicians and patients do next?

For elective surgery, the path is clear: complete the preoperative evaluation with adequate lead time, use the ACS NSQIP Surgical Risk Calculator to generate patient-specific risk estimates, address modifiable risk factors through optimization, schedule an anesthesiology clinic visit for intermediate- to high-risk patients, and document shared decision-making in the chart.

For urgent surgery, the priorities are: stabilize active medical problems, complete the highest-yield assessment items (airway, anticoagulation, cardiac status, allergies), document all unresolved issues for the operative team, and obtain informed consent with realistic risk communication given the compressed timeline.

Targeted testing, not routine panels, is the standard of care. Routine preoperative testing without clinical indication often triggers cascades of additional workup that delay surgery without improving outcomes. Every test ordered should answer a specific management question.

Shared decision-making is not optional. Document that you discussed patient-specific risk estimates, that the patient understood the risks and alternatives, and that the decision to proceed was made collaboratively. This protects patients and clinicians alike.

Where to find authoritative calculators and guidelines

These are the primary sources clinicians and informed patients should consult for detailed methods, calculators, and clinical guidance:

• ACS NSQIP Surgical Risk Calculator: The primary tool for generating patient-specific postoperative risk estimates. Enter the CPT code and clinical variables to get individualized probability outputs across multiple outcome categories.
• Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator (PMC): The peer-reviewed validation study describing the calculator's methodology, discrimination, calibration, and the Surgeon Adjustment Score mechanism. Read this to understand the model's strengths and limitations.
• Preoperative Evaluation for Noncardiac Surgery in Adults (UpToDate): The most comprehensive clinical review for clinicians, covering H&P, testing, cardiac and pulmonary assessment, and medication management. Requires institutional or personal subscription.
• Preoperative Evaluation of the Surgical Patient (PMC): A freely accessible clinical review covering the full scope of preoperative assessment, including targeted testing principles and risk stratification.
• Perioperative Risk Indices and Scores (PMC): A systematic review of organ-system-specific risk tools (ARISCAT for pulmonary risk, SPARK for AKI, and others). Open when the clinical exam points to a specific organ-system concern.
• Preoperative Medicine: Evaluating and Optimizing Patients Before Anesthesia and Surgery (Springer): A current review covering prehabilitation, anesthesiology-directed preop clinics, and outcome data. Useful for clinicians building or refining a preoperative program.

Garden State Medical Group's approach to preoperative preparation

At Garden State Medical Group, preoperative preparation is a coordinated effort across primary care, cardiopulmonary services, and on-site radiology and diagnostics. Rather than sending patients to multiple separate facilities for their preoperative workup, the practice integrates the history and physical, targeted laboratory testing, ECG, and cardiopulmonary evaluation under one roof at its North Bergen and Secaucus locations. This means that when your primary care provider identifies a cardiac or pulmonary concern during your preoperative visit, a referral to cardiopulmonary care or on-site diagnostic testing can happen quickly, without the delays that come from coordinating across unconnected providers.

Clinicians should note that practice-specific workflows vary by institution, and all perioperative decisions should follow local protocols and the guidance of the treating surgical and anesthesia teams.

Coordinated preoperative care at Garden State Medical Group

Patients in North Bergen and Secaucus who need a preoperative evaluation before an elective procedure have a clear path at Garden State Medical Group. The practice's primary care team conducts the focused history, physical exam, medication reconciliation, and risk stratification that form the core of any preoperative assessment. When cardiac or pulmonary concerns arise, the integrated cardiopulmonary and radiology services mean targeted testing happens at the same location, reducing the time between evaluation and results.

For patients managing diabetes, hypertension, or other chronic conditions before surgery, Garden State Medical Group's multidisciplinary programs support the optimization steps that matter most: glycemic control, blood pressure management, and nutritional support. The practice accepts Medicare, Medicaid, and most major insurance plans. To schedule your preoperative evaluation, contact Garden State Medical Group directly through the website or call the North Bergen or Secaucus office to book an appointment with a primary care provider.

Sources

• ACS NSQIP Surgical Risk Calculator
• Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator: A Decision Aide and Informed Consent Tool for Patients and Surgeons - PMC
• Preoperative Evaluation of the Surgical Patient - PMC
• Preoperative medicine: evaluating and optimizing patients before anesthesia and surgery | Anesthesiology and Perioperative Science | Springer Nature Link
• Preoperative evaluation for noncardiac surgery in adults - UpToDate
• Perioperative risk indices and scores (review) - PMC

FAQ

How many days before surgery should you complete the pre-op evaluation?

For elective procedures, the preoperative evaluation should be completed at least two to four weeks before surgery for intermediate-risk patients, and four to six weeks ahead for high-risk cases. This allows time to act on findings, adjust medications, and complete any specialist consultations before the scheduled date.

How long does a preanesthesia evaluation take?

A preanesthesia evaluation typically takes around 30 minutes for a straightforward patient and longer for complex cases with significant comorbidities or a potentially difficult airway. Completing it before the day of surgery, rather than on the morning of the procedure, prevents last-minute delays and cancellations.

Who performs a pre-op assessment?

The preoperative medical evaluation is typically performed by a primary care provider or internist, while the preanesthesia evaluation is conducted by an anesthesiologist or CRNA. For complex patients, both evaluations occur before the day of surgery, with results shared across the surgical and anesthesia teams.

What questions are asked during a preanesthesia evaluation?

The anesthesiologist or CRNA will ask about prior anesthesia experiences (including any complications), current medications and supplements, allergies, history of difficult intubation, cardiac and pulmonary symptoms, and NPO status. Airway anatomy is assessed in person, and the anesthetic plan is discussed with the patient before the procedure.

When should surgery be delayed or canceled based on the evaluation?

Surgery should be delayed when active cardiac conditions are present (unstable angina, decompensated heart failure, severe valvular disease), when a modifiable risk factor can be meaningfully improved with additional time (poorly controlled diabetes, untreated anemia, active respiratory infection), or when the patient's informed consent capacity is in question and a surrogate has not yet been identified.

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