Preoperative Evaluation and Risk Assessment

Preoperative preparation of the cardiac surgery patient is a multi-system, multi-disciplinary endeavor. Assessment begins with a thorough history and physical, as the function of nearly every physiological system has the potential to affect the outcome for a patient undergoing cardiac surgery. It also typically includes basic lab work, chest X-ray, and electrocardiogram, as well as more extensive cardiac- and pulmonary-specific testing. The goals of preoperative evaluation and risk assessment are to assist the surgeon with preoperative technical planning; optimize the preoperative health and medical robustness of the patient; adequately prepare for special postoperative care needs; and to assist the surgeon and patient in the conduct of fully informed, preoperative shared decision-making. In this chapter, we describe the components of preoperative preparation and risk assessment, including cardiac testing, and we provide a framework by which to evaluate the patient preparing for cardiac surgery. These are the approaches used in the Division of Cardiac Surgery at the Massachusetts General Hospital; practices may vary locally at other institutions, but the general principles will be similar.