Pre-operative assessment and optimisation

It is the Wednesday before Mrs Lim's hysterectomy. She is 58, has a body mass index of 32, an Hb of 96 g/L, a HbA1c of 8.4%, and she has been smoking fifteen cigarettes a day for thirty years. The pre-admission clinic is where the registrar turns a list of comorbidities into a written escalation plan for the next three weeks. This topic is the script for that conversation — and the exam answer that earns full marks.^[15]

Overview and definition

Pre-operative assessment is the structured clinical encounter — weeks before elective surgery — that converts the surgical indication into a risk-stratified, optimised patient. It has three complementary parts: ^[14][15]

• Assessment — history, examination, targeted investigations, risk scoring (ASA, RCRI, ARISCAT, Caprini, STOP-Bang).
• Optimisation — correction of modifiable risk: anaemia, glycaemia, nutrition, smoking, alcohol, deconditioning.
• Preparation — fasting instructions, carbohydrate loading, VTE prophylaxis plan, analgesia plan, consent, ERAS education, anaesthetic review.

The day-of-surgery review is a safety check, not a re-assessment. If new information emerges at the door, the plan is communicated to the anaesthetist and the surgeon before the WHO Surgical Safety Checklist begins.^[3][14]