Planning and preparing for the operation: Guidelines and the evidence-based decision tree

Abstract

Surgical interventions induce a stress response whose magnitude depends on the pathology being treated, as well as many other factors such as the surgical approach, and the acuity of the procedure, among others. Additional factors accounting for the surgical risk include the complexity of the surgery and the patient’s premorbid conditions. There are different predictive models to estimate cardiac risks for patients undergoing non-cardiac surgery. One of the first described is the Goldman Multifactorial Risk Index developed in 1977, followed by the Detsky’s Cardiac Risk Index in 1986, the Eagle’s Cardiac Risk Index in 1989, and more recently by the Revised Cardiac Risk Index popularized by Lee in 1999. One of the most widespread tools used by anesthesiologist is the American Society of Anesthesiologist Physical Status Classification, which stratifies patients in six classes. There are several factors to be considered to decrease the overall risk of cardiac-related and all-cause surgical morbidity and mortality. The type and length of anesthesia is one of them, along with the impact that each organ specific pathology may have on the planned operation. This review highlights some of the more important aspects of planning and preparing for an operation, starting with the assessment of its risk and benefits based on the preoperative evaluation and the outcome expected.