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Anaes TopicsPreoperative assessment & risk

Anaes · Preoperative assessment & risk

Preoperative assessment and risk stratification

Also known as Preoperative assessment · ASA-PS · METs · RCRI · Revised cardiac risk index · CPET · Shared decision-making

Exam-exhaustive preoperative assessment: functional capacity in METs, exact ASA-PS classes, RCRI six predictors with risk steps, when to order tests, shared decision-making for high-risk surgery, and day-of-surgery cancel thresholds.

high3 referencesUpdated 26 July 20267 min readVerification in progress

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ANZCAFRCAABAEDAICFCAI

Red flags

  • Cannot climb one flight of stairs (<4 METs) = poor functional capacity — escalate assessment for major surgery.
  • Active cardiac conditions (unstable coronary syndrome, decompensated HF, significant arrhythmia, severe valve disease) stop elective lists until evaluated.
  • RCRI ≥3 ≈ 11% major cardiac event risk — plan monitoring, optimisation, and shared decision-making.
  • Day-of cancel for uncontrolled acute illness, new unstable cardiac symptoms, or inadequate fasting/airway plan — not for mild anxiety alone.
  • Tests without a decision pathway are waste; order investigations that change management.
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Your progress

Saved on this device.

Practise this topic8 MCQs with explanations

Target exams

ANZCAFRCAABAEDAICFCAI

Red flags

  • Cannot climb one flight of stairs (<4 METs) = poor functional capacity — escalate assessment for major surgery.
  • Active cardiac conditions (unstable coronary syndrome, decompensated HF, significant arrhythmia, severe valve disease) stop elective lists until evaluated.
  • RCRI ≥3 ≈ 11% major cardiac event risk — plan monitoring, optimisation, and shared decision-making.
  • Day-of cancel for uncontrolled acute illness, new unstable cardiac symptoms, or inadequate fasting/airway plan — not for mild anxiety alone.
  • Tests without a decision pathway are waste; order investigations that change management.
The one-line answer

Preoperative assessment is triage before technique — triage urgency, exclude active cardiac conditions, estimate functional capacity in METs, count the six Revised Cardiac Risk Index predictors, optimise what is modifiable, order only tests that will change management, and make the high-risk decision with the patient and surgeon.[1][2]

Meet the patient

A 68-year-old smoker with controlled hypertension and a recent HbA1c of 9 percent is booked for an open colectomy for cancer. He cannot climb the flight of stairs to your clinic without stopping to catch his breath, and the surgeon wants to operate on Friday. Three questions decide whether Friday is safe: how urgent is this, is his heart fit, and does any further test actually change the plan.[1]

Hold those three — urgency, fitness, and decision-changing tests — and the whole of preoperative assessment slots into place behind them.[1]

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References3ShowHide
  1. [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
  2. [2]Kristensen SD 2014 ESC/ESA guidelines on noncardiac surgery: Cardiovascular assessment and management : Are the differences clinically relevant? The European perspective J Nucl Cardiol, 2017.PMID 27538569
  3. [3]Older PO, Levett DZH. Cardiopulmonary Exercise Testing and Surgery Ann Am Thorac Soc, 2017.PMID 28511024

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