Preoperative evaluation of hospitalized patients.

Carefully managing patients undergoing elective surgeries is difficult in the perioperative setting. However, this becomes increasingly complex in patients hospitalized for acute conditions that may or may not be related to the pending surgery. Not only must the consulting physician take into consideration any complications inherent to the surgical procedure, but must also consider all related comorbidities of the acute condition for which the patient was initially hospitalized plus any existing chronic conditions. A careful systematic approach should be undertaken in these circumstances, which consists of (1) perioperative risk stratification, (2) medical optimization, and (3) perioperative risk reduction. Risk stratification is determined by the patient's inherent perioperative cardiac risk factors, whereas medical optimization and risk reduction are actively determined during the hospital course. For perioperative risk stratification, the Revised Cardiac Risk Index is the simplest tool for accurately identifying those patients at increased perioperative risk for cardiac mortality and morbidity. Medical optimization involves performing any necessary preoperative testing that would help identify concurrent undiagnosed medical conditions that might require preoperative intervention or the initiation of certain medication regimens to optimize disease treatment. Lastly, perioperative risk reduction includes any modalities that would be started to decrease the risk of potential perioperative cardiac, pulmonary, or other surgery-related comorbidities.