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Preoperative Risk Stratification: Identifying Modifiable Risks for Optimization

  • Prehabilitation (B Riedel and S Jack, Section Editors)
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Abstract

Purpose of Review

This chapter aims to examine current strategies for risk stratification in the preoperative setting. Risk stratification tools may include commercially available calculators, laboratory assessments, or screening tests. Risk stratification informs the surgical team on the need for preoperative optimization of modifiable risks. Optimization aims to improve clinical, hospital, and patient-centered outcomes across all phases of perioperative care. Preoperative optimization should be a collaborative, multidisciplinary effort that balances the patient’s needs and values with the timing and urgency of surgery.

Recent Findings

Preoperative patient optimization is feasible, improves patient satisfaction, reduces clinical complications, and lowers hospital costs.

Summary

Preoperative physicians are encouraged to use risk stratification tools to identify patients with modifiable risks and implement optimization plans to mitigate postoperative complications.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham (UAB Medicine), JT 845, 619 South 19th Street, AL, 35249-6810, Birmingham, USA

    Matthew Sherrer, Jeffrey W. Simmons & Jeffrey B. Dobyns

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  1. Matthew Sherrer
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Correspondence to Jeffrey B. Dobyns.

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This article is part of the Topical Collection on Prehabilitation

Search Strategy

The authors of this chapter currently lead the preoperative optimization effort at the University of Alabama at Birmingham (UAB Medicine). The Preoperative Assessment, Consultation, and Treatment Clinic (PACT) focuses on identifying modifiable conditions in surgical patients, and we have developed optimization strategies for these. Modifiable conditions include smoking cessation, hyperglycemia, hypertension, malnutrition, poor dentition, elder care and frailty, obstructive sleep apnea, anemia, opioid use, and cardiac risk assessment. The authors examined current topics discussed at the American Society of Enhanced Recovery (ASER) and Society for Perioperative Assessment and Quality Improvement (SPAQI) conferences for inclusion in this chapter. Both societies focus on perioperative optimization for modifiable risks and improvement of patient outcomes. The most useful risk stratification tools were selected based on the authors’ experience and examination of “hot topics” at recent annual meetings.

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Sherrer, M., Simmons, J.W. & Dobyns, J.B. Preoperative Risk Stratification: Identifying Modifiable Risks for Optimization. Curr Anesthesiol Rep 12, 10–25 (2022). https://doi.org/10.1007/s40140-022-00519-z

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