Preoperative medical consultation and evaluation of surgical risk.

Internists are frequently asked to assess the surgical risk of patients with various medical problems. Numerous recent prospective studies have defined specific risk factors for increased morbidity and mortality in the preoperative evaluation of surgical patients. Careful attention to such factors as age, type of operation and anesthesia, underlying pulmonary, hypertensive, cardiac, renal, hepatic, endocrine, and hematologic diseases, and nutritional status can reduce the complication rate and death rate in surgical patients if specific preoperative, operative, and postoperative therapeutic maneuvers are instituted. A comprehensive comparative analysis by the internist, surgeon, and anesthesiologist should be made on all high-risk surgical patients to improve their medical care.