Optimizing the surgical patient?

Current surgical and anaesthesia literature contains a wide range of optimization strategies across an array of surgical disciplines. This concise article reviews this literature for pre- and perioperative optimization. It is focused upon initial assessment, risk stratification and the options available to improve outcome. Multiple preoperative interventions are considered and the evidence to support their use is provided. Perioperative techniques are discussed along with fluid monitoring and volume strategies. The strategies we discuss can either be used alone in the emergency setting or combined into an established fast track surgical programme. Many of these strategies can be introduced with little initial investment relative to the potential for improved outcome they provide. This article provides an up-to-date clinical summary and it will be helpful to surgeons and anaesthetists working across a range of specialities in both secondary and tertiary care centres.