KEY POINTS

1. The ultimate goals of preoperative and preprocedure medical assessment of patients who are receiving anesthesia care are to reduce the morbidity of surgery, to increase the quality but decrease the cost of perioperative care, and to return the patient to desirable functioning as quickly as possible.
2. The basis for preoperative and preprocedure evaluation are data demonstrating that patient conditions and perioperative optimization of care are significant predictors of postoperative morbidity.
3. Preoperative and preprocedure evaluation offer an opportunity to motivate a patient to achieve a higher quality of life and thereby improve long-term as well as immediate outcome.
4. The three areas of acute history that impact perioperative evaluation are exercise tolerance, history of present illness, and when the patient last visited with her/his primary care physician.
5. The three aspects of chronic history that impact perioperative evaluation are medications and reasons for their use, and allergies; social history, including drug, alcohol, and tobacco use and cessation; and family history and history of prior illness.
6. The three aspects of the physical examination are airway, cardiovascular and pulmonary evaluation.
7. In general, not much benefit appears to arise from unindicated routine laboratory testing, and testing should be reserved for those for whom the results may lead to improved care or avoidance of a potential problem.
8. In 2002 the ASA, because of a lack of conclusive data to produce an evidence-based guideline, produced a preoperative testing advisory, which outlined the available studies and provided details regarding consultants' opinions on the value of different diagnostic tests.
9. The extent of a surgical procedure influences the need for routine testing; low-risk procedures require no or minimal diagnostic testing.
10. Informatics may be critical to the efficient and effective preoperative evaluation by ensuring accurate transfer of information to the anesthesia team.