Risk assessment in anaesthesia

National audit indicates that formal and documented assessment of perioperative risk is performed infrequently and inadequately by clinicians in the preoperative period. Many tools exist to assist the anaesthetist with this role and should be used in conjunction with clinical judgement. The presence of frailty has been found to increase the risk of adverse outcome following surgery and guidance recommends frailty screening as part of a preoperative assessment for older adults. Functional capacity strongly correlates with risk of postoperative major adverse cardiac events and should be assessed preoperatively. The role of cardiopulmonary exercise testing for the purpose of functional capacity assessment and prognostication of outcome is continually evolving. Once a patient's risk has been assessed, it should be used to plan an appropriate perioperative care pathway and to inform the process of shared decision-making.