Surgery Today

, Volume 40, Issue 2, pp 108–113 | Cite as

Preoperative evaluation and a risk assessment in patients undergoing abdominal surgery

  • Siyamek Neragi-Miandoab
  • Michael Wayne
  • Michael Cioroiu
  • Lee M. Zank
  • Christopher Mills
Review Article


Patients who undergo abdominal surgery present along a variable spectrum of health. This ranges from the healthy young patient undergoing elective hemorrhoid surgery to the octogenarian in unstable health with multiple comorbidities. Regardless of a patient’s current state of health, a preoperative assessment is crucial in planning the operative approach and in recognizing the possible postoperative complications for the implementation of a proper intervention if necessary. A broad evaluation of the patient includes identifying conditions that may predispose the patient to risks and the complications not directly related to the surgical procedure. The purpose of this article is to review the preoperative assessment in patients undergoing simple to complex procedures. The article provides general guidelines for the preoperative workup, which should be individualized for each patient, and the planned procedure, with the goal of reducing the postoperative complications. Risk stratification depends on a patient’s condition and the extension of the planned surgical approach. It may also help to improve the postoperative outcome. A further preoperative workup should be individualized and tailored to the complexity of each case.

Key words

Abdominal surgery Risk assessment Preoperative workup Postoperative outcome 


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  1. 1.
    Heijmans JH, Maessen JG, Roekaerts PM. Risk stratification for adverse outcome in cardiac surgery. Eur J Anaesthesiol 2003;20:515–527.CrossRefPubMedGoogle Scholar
  2. 2.
    Akhtar S, Silverman DG. Assessment and management of patients with ischemic heart disease. Crit Care Med 2004;32:S126–S136.CrossRefPubMedGoogle Scholar
  3. 3.
    Rigberg DA, Zingmond DS, McGory ML, Maggard MA, Agustin M, Lawrence PF, et al. Age stratified, perioperative, and one-year mortality after abdominal aortic aneurysm repair: a statewide experience. J Vasc Surg 2006;43:224–229.CrossRefPubMedGoogle Scholar
  4. 4.
    Mukherjee D, Fang J, Chetcuti S, Moscucci M, Kline-Rogers E, Eagle KA. Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation 2004;109:745–749.CrossRefPubMedGoogle Scholar
  5. 5.
    Akhtar S, Assaad S, Amin M, Holt NF, Barash PG, Silverman DG. Preoperative beta-blocker use: impact of national guidelines on clinical practice. J Clin Anesth 2008;20:122–128.CrossRefPubMedGoogle Scholar
  6. 6.
    Arvidsson S, Ouchterlony J, Sjostedt L, Svardsudd K. Predicting postoperative adverse events. Clinical efficiency of four general classification systems. The project perioperative risk. Acta Anaesthesiol Scand 1996;40:783–791.CrossRefPubMedGoogle Scholar
  7. 7.
    Badner NH, Craen RA, Paul TL, Doyle JA. Anaesthesia preadmission assessment: a new approach through use of a screening questionnaire. Can J Anaesth 1998;45:87–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989;64:651–654.CrossRefPubMedGoogle Scholar
  9. 9.
    Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 1999;159:2185–2192.CrossRefPubMedGoogle Scholar
  10. 10.
    Varela G, Novoa NM. Future trends in preoperative evaluation. Thorac Surg Clin 2008;18:31–37.CrossRefPubMedGoogle Scholar
  11. 11.
    Mancuso CA. Impact of new guidelines on physicians’ ordering of preoperative tests. J Gen Intern Med 1999;14:166–172.CrossRefPubMedGoogle Scholar
  12. 12.
    Greer AE, Irwin MG. Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital. Anaesth Intensive Care 2002;30:326–330.PubMedGoogle Scholar
  13. 13.
    Ricciardi G, Angelillo IF, Del Prete U, D’Errico MM, Grasso GM, Gregorio P, et al. Routine preoperative investigation. Results of a multicenter survey in Italy. Collaborator Group. Int J Technol Assess Health Care 1998;14:526–534.CrossRefPubMedGoogle Scholar
  14. 14.
    McKee RF, Scott EM. The value of routine preoperative investigations. Ann R Coll Surg Engl 1987;69:160–162.PubMedGoogle Scholar
  15. 15.
    Muskett AD, McGreevy JM. Rational preoperative evaluation. Postgrad Med J 1986;62:925–928.CrossRefPubMedGoogle Scholar
  16. 16.
    Roizen M. Preoperative patient evaluation. Can J Anaesth 1989;36:S13–S19.CrossRefPubMedGoogle Scholar
  17. 17.
    Macario A, Roizen MF, Thisted RA, Kim S, Orkin FK, Phelps C. Reassessment of preoperative laboratory testing has changed the test-ordering patterns of physicians. Surg Gynecol Obstet 1992;175:539–547.PubMedGoogle Scholar
  18. 18.
    Klotz HP, Candinas D, Platz A, Horvàth A, Dindo D, Schlumpf R, et al. Preoperative risk assessment in elective general surgery. Br J Surg 1996;83:1788–1791.CrossRefPubMedGoogle Scholar
  19. 19.
    Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974;2:57–60.PubMedGoogle Scholar
  20. 20.
    Keene AR, Cullen DJ. Therapeutic Intervention Scoring System: update 1983. Crit Care Med 1983;11:1–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Lemeshow S, Teres D, Avrunin JS, Pastides H. A comparison of methods to predict mortality of intensive care unit patients. Crit Care Med 1987;15:715–722.PubMedGoogle Scholar
  22. 22.
    Matsusue S, Kashihara S, Koizumi S. Prediction of mortality from septic shock in gastrointestinal surgery by probit analysis. Jpn J Surg 1988;18:18–22.CrossRefPubMedGoogle Scholar
  23. 23.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefPubMedGoogle Scholar
  24. 24.
    Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med 1981;9:672–676.CrossRefPubMedGoogle Scholar
  25. 25.
    Haga Y, Wada Y, Takeuchi H, Kimura O, Furuya T, Sameshima H, et al. Estimation of physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery. Surgery 2004;135:586–594.CrossRefPubMedGoogle Scholar
  26. 26.
    Lawrence VA, Dhanda R, Hilsenbeck SG, Page CP. Risk of pulmonary complications after elective abdominal surgery. Chest 1996;110:744–750.CrossRefPubMedGoogle Scholar
  27. 27.
    Greenburg AG, Saik RP, Pridham D. Influence of age on mortality of colon surgery. Am J Surg 1985;150:65–70.CrossRefPubMedGoogle Scholar
  28. 28.
    Mullen JL, Buzby GP, Waldman MT, Gertner MH, Hobbs CL, Rosato EF. Prediction of operative morbidity and mortality by preoperative nutritional assessment. Surg Forum 1979;30:80–82.PubMedGoogle Scholar
  29. 29.
    Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139:160–167.CrossRefPubMedGoogle Scholar
  30. 30.
    Boyd JB, Bradford B, Jr., Watne AL. Operative risk factors of colon resection in the elderly. Ann Surg 1980;192:743–746.CrossRefPubMedGoogle Scholar
  31. 31.
    Cooperman M, Pflug B, Martin, EW Jr, Evans WE. Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 1978;84:505–509.PubMedGoogle Scholar
  32. 32.
    Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986;1:211–219.CrossRefPubMedGoogle Scholar
  33. 33.
    Dosluoglu HH, Wang J, Defranks-Anain L, Rainstein M, Nader ND. A simple subclassification of American Society of Anesthesiology III patients undergoing peripheral revascularization based on functional capacity. J Vasc Surg 2008;47:766–773.CrossRefPubMedGoogle Scholar
  34. 34.
    Menke H, Klein A, John KD, Junginger T. Predictive value of ASA classification for the assessment of the perioperative risk. Int Surg 1993;78:266–270.PubMedGoogle Scholar
  35. 35.
    Bowles TA, Sanders KM, Colson M, Watters DA. Simplified risk stratification in elective colorectal surgery. Aust NZ J Surg 2008;78:24–27.CrossRefGoogle Scholar
  36. 36.
    Wolters U, Mannheim S, Wassmer G, Brunkwall J. What is the value of available risk-scores in predicting postoperative complications after aorto-iliac surgery? A prospective non randomized study. J Cardiovasc Surg (Torino) 2006;47:177–185.Google Scholar
  37. 37.
    Agarwal N, Leighton L, Mandile MA, Cayten CG. Outcomes of surgery for colorectal cancer in patients age 80 years and older. Am J Gastroenterol 1990;85:1096–1101.PubMedGoogle Scholar
  38. 38.
    Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. Acta Anaesthesiol Scand 1990;34:176–182.CrossRefPubMedGoogle Scholar
  39. 39.
    Ondrula DP, Nelson RL, Prasad ML, Coyle BW, Abcarian H. Multifactorial index of preoperative risk factors in colon resections. Dis Colon Rectum 1992;35:117–122.CrossRefPubMedGoogle Scholar
  40. 40.
    Keats AS. The ASA classification of physical status — a recapitulation. Anesthesiology 1978;49:233–236.CrossRefPubMedGoogle Scholar
  41. 41.
    Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996;77:217–222.PubMedGoogle Scholar
  42. 42.
    Hirose J, Mizuta H, Ide J, Nomura K. Evaluation of estimation of physiologic ability and surgical stress (E-PASS) to predict the postoperative risk for hip fracture in elder patients. Arch Orthop Trauma Surg 2008;128:1447–1452.CrossRefPubMedGoogle Scholar
  43. 43.
    Haga Y, Ikei S, Wada Y, Takeuchi H, Sameshima H, Kimura O, et al. Evaluation of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict postoperative risk: a multicenter prospective study. Surg Today 2001;31:569–574.CrossRefPubMedGoogle Scholar
  44. 44.
    Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845–850.PubMedCrossRefGoogle Scholar
  45. 45.
    Jakobsson A, White T. Routine preoperative electrocardiograms. Lancet 1984;1:972.CrossRefPubMedGoogle Scholar
  46. 46.
    Dorman T, Breslow MJ, Pronovost PJ, Rock P, Rosenfeld BA. Bundle-branch block as a risk factor in noncardiac surgery. Arch Intern Med 2000;160:1149–1152.CrossRefPubMedGoogle Scholar
  47. 47.
    Murdoch CJ, Murdoch DR, McIntyre P, Hosie H, Clark C. The pre-operative ECG in day surgery: a habit? Anaesthesia 1999;54:907–908.CrossRefPubMedGoogle Scholar
  48. 48.
    Goldberger AL, O’Konski M. Utility of the routine electrocardiogram before surgery and on general hospital admission. Critical review and new guidelines. Ann Intern Med 1986;105:552–557.PubMedGoogle Scholar
  49. 49.
    Velanovich V. Preoperative screening electrocardiography: predictive value for postoperative cardiac complications. South Med J 1994;87:431–434.CrossRefPubMedGoogle Scholar
  50. 50.
    Hashimoto J, Nakahara T, Bai J, Kitamura N, Kasamatsu T, Kubo A. Preoperative risk stratification with myocardial perfusion imaging in intermediate and low-risk non-cardiac surgery. Circ J 2007;71:1395–1400.CrossRefPubMedGoogle Scholar
  51. 51.
    Bai J, Hashimoto J, Nakahara T, Kitamura N, Suzuki T, Kubo A. Preoperative risk evaluation in diabetic patients without angina. Diabetes Res Clin Pract 2008;81:150–154.CrossRefPubMedGoogle Scholar
  52. 52.
    Tisi GM. Preoperative evaluation of pulmonary function. Validity, indications, and benefits. Am Rev Respir Dis 1979;119:293–310.PubMedGoogle Scholar
  53. 53.
    Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute. National Asthma Education Program. Expert Panel Report. J Allergy Clin Immunol 1991;88:425–534.Google Scholar
  54. 54.
    Rucker L, Frye EB, Staten MA. Usefulness of screening chest roentgenograms in preoperative patients. JAMA 1983;250:3209–3211.CrossRefPubMedGoogle Scholar
  55. 55.
    Charpak Y, Blery C, Chastang C, Szatan M, Fourgeaux B. Prospective assessment of a protocol for selective ordering of preoperative chest x-rays. Can J Anaesth 1988;35:259–264.CrossRefPubMedGoogle Scholar
  56. 56.
    Archer C, Levy AR, McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth 1993;40:1022–1027.CrossRefPubMedGoogle Scholar
  57. 57.
    Navare SM, Mather JF, Shaw LJ, Fowler MS, Heller GV. Comparison of risk stratification with pharmacologic and exercise stress myocardial perfusion imaging: a meta-analysis. J Nucl Cardiol 2004;11:551–561.CrossRefPubMedGoogle Scholar
  58. 58.
    Grayburn PA, Hillis LD. Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Ann Intern Med 2003;138:506–511.PubMedGoogle Scholar
  59. 59.
    Yokoshima T, Honma H, Kusama Y, Munakata K, Takano T, Nakanishi K. Improved stratification of perioperative cardiac risk in patients undergoing noncardiac surgery using new indices of dobutamine stress echocardiography. J Cardiol 2004;44:101–111.PubMedGoogle Scholar
  60. 60.
    Auerbach AD, Goldman L. Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 2002;287:1435–1444.CrossRefPubMedGoogle Scholar
  61. 61.
    McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery 2005;138:171–179.CrossRefPubMedGoogle Scholar
  62. 62.
    Koizumi M, Sata N, Yasuda Y, Nagai H, Saito Y, Hayashi Y, et al. Preoperative cardiac evaluation: when should the surgeon consult the cardiologist? Surg Today 2006;36:425–435.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Siyamek Neragi-Miandoab
    • 1
  • Michael Wayne
    • 1
  • Michael Cioroiu
    • 1
  • Lee M. Zank
    • 2
  • Christopher Mills
    • 1
  1. 1.Department of Surgery, St. Vincent’s Medical CenterNew York Medical College, School of MedicineNew YorkUSA
  2. 2.Department of Anesthesiology, St. Vincent’s Medical CenterNew York Medical College, School of MedicineNew YorkUSA

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