Surgical interventions have become increasingly common, driven both by a growing interest in cosmetic procedures and by advances in technology that have transformed many previously high-risk, inpatient operations into minimally invasive outpatient procedures.
Despite these advances, many surgical procedures—whether cosmetic, elective, or medically necessary—still require careful preoperative evaluation before a patient undergoes anesthesia.
First and foremost, patients must have a clear understanding of the risks, benefits, and alternatives associated with any surgical intervention before consenting to proceed. Once this decision is made, patients are typically referred to their primary care physician for a preoperative evaluation. The American Heart Association (AHA) and the American College of Cardiology (ACC) have developed joint recommendations to guide clinicians in this process.
Primary care physicians conduct preoperative assessments by evaluating both patient-specific risk factors and the inherent risks associated with the planned surgical procedure.
Patient-specific risk assessment includes a thorough history and physical examination, with particular attention to significant comorbidities—especially cardiovascular disease. Functional capacity is also assessed to determine baseline exercise tolerance, as the physiologic stress of major surgery is often comparable to vigorous activity requiring greater than 6 metabolic equivalents (METs). Clinicians may then estimate the likelihood of perioperative cardiac events using validated tools such as the Revised Cardiac Risk Index (RCRI), which incorporates both patient comorbidities and the risk level of the surgery. High-risk procedures generally include intraperitoneal, intrathoracic, suprainguinal, and vascular surgeries. These assessments are particularly relevant for patients over the age of 45, or for younger patients with known cardiovascular disease.
Only patients identified as having a high risk of perioperative complications—and for whom intervention would meaningfully reduce that risk—should undergo invasive testing, such as cardiac catheterization. All patients should be medically optimized prior to surgery, including appropriate management of chronic medications. In some cases, medications such as anticoagulants may need to be temporarily held or bridged during the perioperative period.
A multidisciplinary approach is essential. Collaboration between the primary care provider, cardiologist, surgeon, and anesthesiologist ensures the development and execution of a patient-specific care plan. It is equally important for patients and their families to understand that surgical outcomes are influenced by multiple factors, including both procedural risks and individual health status. Recognizing these elements is critical to informed decision-making.
At Saliglasa Direct Primary Care, we offer comprehensive preoperative evaluations and postoperative follow-up care. Our approach incorporates both AHA/ACC guidelines and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk assessment tool. In addition to estimating cardiac risk, the NSQIP tool provides patient-specific predictions of a broad range of postoperative complications, supporting both surgical planning and informed consent.
While we cannot eliminate the inherent risks of surgery, we can inform, optimize, and advocate for our patients. By working closely with surgical teams, we aim to improve outcomes and ensure that each patient approaches surgery with clarity, preparation, and confidence.