Pre-operative outpatient medical evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries. To effectively provide this consultative service, the physician should understand the risk associated with the particular type of surgery planned and relate this risk to the patient's underlying acute and chronic medical problems.

The main role of preoperative control is:

• To determine the risk of morbidity related to the type of surgery chosen to treat the present disease
• To identify all patient factors that require preoperative management to mitigate the risk of morbidity and mortality

The complete preoperative evaluation includes the following sections:

• Patient's personal history
  
  • General Health
  • Genetic material disorders
  • Hereditary Diseases
  • Disability
  • Infectious Diseases
  • Lesions
  • Surgical Interventions
  • Transplants
  • Dental Interventions
  • Hospitalizations
  • Intravenous Infusions and transfusions of blood factors
  • Blood donation
  • Radiotherapy
  • Introduction of Foreign Prefixes or Mechanisms
  • Peritoneal Dialysis and Artificial Kidney Vaccinations
  • Pathological Systems History
  • Natural therapies
  • Social Background
  • Family History
  • Obstetric - Gynaecological History (only for women)

• Clinical examination of the patient
  
  • How to approach the patient
  • Clinical Assessment Information Source
  • History of Present Disease
  • Performance Status
    
    • Karnofsky score (80 to 100 percent)
    • Zubrod (Eastern Cooperative Oncology Group [ECOG] ) system (0-1)
  • Functional Status
    
    • 6-min walk
      
      • ability of the patient to walk at least 480m (1600 ft) in 6min
    • Stair climbing
      
      • patient's ability to climb 5 floors (patient has significant disability when pulse oximeter oxygen saturation drops more than 4% of the initial measurement during the test)
    • Shuttle walk
      
      • ability of the patient to walk around two cones (distance between them about 9m) in circles (completing 25 circles is equivalent to a VO2 of about 10 mL/kg/min)
  • Initial Evalution
    
    • Vital Signs
    • Somatometrics
    • General Health
  • Examination by System

• Consideration
  
  • Differential Diagnosis
    
    • Differential diagnosis is the scientific, diagnostic process in which the medical team, based on the information obtained from the patient's symptomatology, personal history and clinical examination (and semiotics), summarises and prioritises the most likely medical diagnoses that tend to adequately explain the patient's pathological condition. Subsequently, by carrying out step-by-step and causal paraclinical diagnostic tests, the medical team shall exclude the least likely diagnoses in order to decide on the most predominant and final diagnosis.

• Paraclinical examinations
  
  • Full biochemical testing
  • Blood Tests
  • Coagulation mechanism
  • Infectious indicators
  • Cancer markers
  • Respiratory mechanics (respiratory mechanics)
    
    • FEV1
    • FVC
    • ppo- FEV1 = FEV1 x (1 - [number of resected segments/19]/100)
      
      • ppo: Predicted PostOperative
      • patients with ppo- FEV1 > 40%, are low risk
  • Parenchymal function
    
    • Diffusing capacity for carbon monoxide [DLco]
      
      • ppo-DLco = DLco x (1 - [number of resected segments/19]/100)
      • patients with ppo- FEV1 > 40%, are low risk
  • Cardiopulmonary interaction
    
    • CPEx VO2max
      
      •      < 10 mL/kg/min : high risk
      • 10 to 15 mL/kg/min : intermidiate risk
      • 15 to 20 mL/kg/min : low isk
    • indication for patients with: ppo- FEV1 < 40% ppo-DLco < 40% ppo- FEV1 Χ ppo-DLco < 1650
  • Transthoracic echocardiogram
  • Ventilation Perfusion Lung Scintigraphy
  • Lung perfusion scintigraphy
  • Vibration Response Imaging, VRIxp™
  • Chest Echo
  • Chest CT
  • Brain MRI
  • PET-CT
  • Bronchoscopy
  • Gastroscopy
  • Colonoscopy

• Assessments
  
  • Gynecological Assessment
  • Cardiological Assessment
  • Anesthetic Assessment
  • Endocrine Assessment
  • Neurological Assessment
  • Thoracoscore