Surgical Patient Pre-Operative Assessment & Optimization
Systematically assess surgical fitness and generate evidence-based pre-op optimization plans
What You Can Do
You can systematically evaluate surgical candidates by analyzing comorbidities, functional status, and lab/imaging results to generate evidence-based risk stratification and optimization plans. The skill helps you identify which patients need specialist input, determine pre-operative timeline feasibility, and communicate risk clearly to patients and surgical teams—reducing perioperative morbidity by targeting modifiable factors before surgery.
Features
automatic assessment of American Society of Anesthesiologists risk level based on comorbidities and functional capacity
cardiopulmonary, metabolic, renal, and hematologic workup protocols tailored to patient's specific conditions
identifies which specialists (cardiology, pulmonology, endocrinology, nephrology) require pre-operative input and urgency timeline
structured assessment of exercise tolerance, frailty markers, and physiologic reserve to predict perioperative risk
flags actionable interventions (medication optimization, glucose control, anemia correction, smoking cessation) with timeline feasibility
estimates days-to-ready based on optimization needs and clearance dependencies
quantifies specific complication risks (cardiac events, respiratory failure, thromboembolic, surgical site infection) by comorbidity pattern
translates clinical risk data into plain-language explanations for shared decision-making
Example Output
Example 1: High-Risk Cardiac Patient
Patient: 68M, ASA III, HTN, CAD s/p stent 2yrs ago, EF 45%, planned total knee arthroplasty
Risk Assessment:
- ASA III-E (cardiac disease limits activity)
- Moderate perioperative cardiac risk (5-10% major adverse cardiac event)
- Functional capacity: METS ~4 (limited)
Required Optimization:
- ✓ Cardiology pre-op clearance (obtain within 5 days)
- ✓ Preoperative stress test or imaging (EKG insufficient)
- ✓ Continue dual antiplatelet therapy per cardiology
- ✓ Beta-blocker optimization
- Timeline to surgery: 7-10 days post-clearance
Example 2: Metabolic Syndrome with Pending Lung Disease
Patient: 54F, ASA II, obesity (BMI 34), T2DM (A1C 8.2%), COPD on home O2, planned laparoscopic cholecystectomy
Risk Assessment:
- ASA II (controlled but multiple factors)
- Moderate respiratory risk; aspiration precautions needed
- Moderate metabolic derangement
Required Optimization:
- ✓ Pulmonology clearance + spirometry (obtain within 3 days)
- ✓ Glucose optimization: review diabetes regimen, target A1C <8 if time allows
- ✓ Home O2 settings review; arrange intraop oxygen protocol
- ✓ Anesthesia pre-op note addressing aspiration risk
- ✓ Nicotine cessation counseling
- Timeline to surgery: 5-7 days; lung clearance is rate-limiting step
What's Included
- SKILL.md: full instruction framework with clinical decision rules and evidence-based assessment pathways
- Pre-Operative Assessment Template: structured intake form capturing cardiopulmonary, metabolic, renal, hematologic, and functional domains
- Comorbidity Risk Lookup Chart: quick-reference guide linking specific conditions (CAD, COPD, CKD, diabetes) to optimization priorities and timeline
- Specialty Referral Decision Tree: flowchart for determining which specialists need input and urgency level
- Patient Communication Worksheet: plain-language risk explanation templates and shared decision-making prompts
Who It's For
- Surgical Physician Assistants — conducting pre-operative evaluations and optimizing patients before elective surgery
- General Surgery Residents — systematizing pre-op assessment and learning structured risk stratification
- Perioperative Medicine Specialists — coordinating complex multi-comorbidity cases and optimizing high-risk patients
- Surgical Nurses/Coordinators — flagging pre-operative gaps and coordinating specialist clearances efficiently
- Anesthesiologists — preparing comprehensive risk profiles and intra-operative management plans from PA assessment data
Best For
- Complex/high-risk surgical patients (ASA ≥III, multiple comorbidities, older adults, obesity)
- Elective cases requiring pre-operative optimization timeline prediction
- Multi-specialty coordination — determining which specialists need input and sequencing referrals
- Risk communication to patients — translating comorbidity data into actionable pre-operative education
- Protocol deviation scenarios — unusual comorbidity combinations requiring custom pre-operative pathways
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