Optimization of the elective and emergency surgical patient

Despite advances in surgical and anaesthetic technique, mortality for high-risk surgical patients remains significant. Increasingly complex surgery is being undertaken in patients with life-limiting co-morbidities. There is convincing evidence to show that if these patients are identified and optimized preoperatively, both mortality and complications are dramatically reduced. This article focuses on how to identify high-risk patients and the theory and methods behind perioperative optimization.