A history and physical examination, focusing on risk factors for cardiac, p
ulmonary and infectious complications, and a determination of a patient's f
unctional capacity, are essential to any preoperative evaluation. In additi
on, the type of surgery influences the overall perioperative risk and the n
eed for further cardiac evaluation. Routine laboratory studies are rarely h
elpful except to monitor known disease states. Patients with good functiona
l capacity do not require preoperative cardiac stress testing in most surgi
cal cases. Unstable angina, myocardial infarction within six weeks and aort
ic or peripheral vascular surgery place a patient into a high-risk category
:for perioperative cardiac complications. Patients with respiratory disease
may benefit from perioperative use of bronchodilators or steroids. Patient
s at increased risk of pulmonary complications should receive instruction i
n deep-breathing exercises or incentive spirometry. Assessment of nutrition
al status should be performed. An albumin level of less than 3.2 mg per dL
(32 g per L) suggests an increased risk of complications. Patients deemed a
t risk because of compromised nutritional status may benefit from pre- and
postoperative nutritional supplementation.