Synopsis
Assess an adult before planned surgery by integrating the proposed operation, functional reserve, comorbidity, medicines, selective testing and modifiable risk into a shared and documented perioperative plan.
- Define the procedure, indication, urgency, expected physiological stress, bleeding risk and likely recovery burden before interpreting any patient factor or score.
- Use a validated risk tool to supplement clinical assessment, then explain absolute outcomes and alternatives; a score does not decide consent, operability or postoperative destination by itself.
- Select tests from the operation grade, ASA status, comorbidity and a clear management question. Do not order routine chest radiography, urine dipstick or coagulation tests for an otherwise well adult without an indication.
Key red flags
A recent major change in exercise tolerance, syncope, exertional chest pain, orthopnoea or new oedema requires focused cardiovascular assessment before a planned anaesthetic.
Current fever, productive cough, hypoxaemia or an infective exacerbation warrants clinical evaluation; a routine chest radiograph is not a substitute for examining a symptomatic patient.
Anaemia, thrombocytopenia, a personal or family bleeding history, previous transfusion antibodies or refusal of blood changes preparation for an operation with blood-loss risk.
Previous difficult airway, malignant hyperthermia, perioperative anaphylaxis, severe postoperative nausea, awareness or unexpected critical-care admission must be retrieved from old records where possible.
Poorly controlled diabetes, recurrent hypoglycaemia, ketosis symptoms or use of an SGLT2 inhibitor during starvation needs a named perioperative glucose and ketone plan.
Clinic blood pressure at or above 180/120 mmHg in an adult attending planned-surgery assessment without acceptable recent readings requires assessment and usually postponement rather than automatic same-day progression.
Treat new chest pain, resting hypoxaemia, sepsis, acute kidney injury, active bleeding or metabolic decompensation as an urgent clinical finding and escalate before continuing routine elective preparation.
Reasoning priorities
Establish active disease, functional change, airway factors and baseline physiology before choosing tests.
A new symptom or abnormal observation triggers focused diagnostic assessment; a normal generic blood panel cannot exclude an unstable clinical syndrome.
Worked reasoning
An adult booked for elective major abdominal surgery reports a recent fall in walking distance and has anaemia on referral blood tests.
- Confirm the cancer or symptom indication and acceptable timing with the surgeon, then characterise breathlessness, chest symptoms, bleeding, nutrition, weight loss, functional decline and the expected operative stress.
- Examine cardiorespiratory and volume status, reconcile medicines and prior anaesthetic records, and request only investigations that answer the suspected anaemia, cardiac, respiratory or renal questions.
- Use an outcome-appropriate validated tool to frame risk, but treat the new functional decline and anaemia as clinical problems requiring explanation rather than accepting a low numerical estimate.
- Investigate anaemia early, treat iron deficiency through the relevant oral or IV route, address nutrition and smoking, and agree whether benefit from optimisation outweighs delay.
- Document the shared decision, medicine instructions, transfusion preferences, postoperative monitoring and escalation plan, and name the clinician who will close each abnormal result.
History, examination and observations reveal no active disease and the proposed procedure has low physiological stress.