• Massimo Lamperti, Carolina S Romero, Fabio Guarracino, Gianmaria Cammarota, Luigi Vetrugno, Boris Tufegdzic, Francisco Lozsan, Juan Jose Macias Frias, Andreas Duma, Matthias Bock, Kurt Ruetzler, Silvia Mulero, Daniel A Reuter, Luigi La Via, Simon Rauch, Massimiliano Sorbello, and Arash Afshari.
• From the Anesthesiology Division, Integrated Hospital Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates (ML, BT, SM), Department of Anesthesia and Intensive Care, University General Hospital of Valencia (CSR). Department of Methodology, Universidad Europea de Valencia, Spain (CSR), Azienda Ospedaliero Universitaria Pisana, Cardiothoracic and vascular Anaesthesia and Intensive Care, Pisa (FG), Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara (GC), Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy (LV), Péterfy Sándor Hospital, Anesthesia and Intensive Care Unit. Budapest, Hungary (FL), Servei d'Anestesiologia i Medicina Periopeatòria, Hospital General de Granollers, Spain (JJMF), Department of Anaesthesia and Intensive Care, University Hospital Tulln, Austria (AD), Department of Anaesthesiology and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano - Meran, Italy (MB), Teaching Hospital of Paracelsus Medical University and Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria (MB), the Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA (KR), Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Rostock University Medical Center, Rostock, Germany (DAR), Anesthesia and Intensive Care. Policlinico "G. Rodolico-San Marco", Catania, Italy (LLV), Department of Anaesthesiology and Intensive Care Medicine, Hospital of Merano (SABES-ASDAA), Merano - Meran (SR), Teaching Hospital of Paracelsus Medical University, Anesthesia and Intensive Care, School of Medicine, Kore University, Enna (SR), Anesthesia and Intensive Care, Giovanni Paolo II Hospital, Ragusa, Italy (SR), Rigshospitalet & Institute of Clinical Medicine, University of Copenhagen (MS) and Department of Paediatric and Obstetric Anaesthesia, Juliane Marie Centre, Rigshospitalet, Denmark University of Copenhagen, Denmark (AA).
• Eur J Anaesthesiol. 2024 Nov 1.

BackgroundWhen considering whether a patient is fit for surgery, a comprehensive patient assessment represents the first step for an anaesthetist to evaluate the risks associated with the procedure and the patient's underlying diseases, and to optimise (whenever possible) the perioperative surgical journey. These guidelines from the European Society of Anaesthesiology and Intensive Care Medicine (ESAIC) update previous guidelines to provide new evidence on existing and emerging topics that consider the different aspects of the patient's surgical path.DesignA comprehensive literature review focused on organisation, clinical facets, optimisation and planning. The methodological quality of the studies included was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. A Delphi process agreed on the wording of recommendations, and clinical practice statements (CPS) supported by minimal evidence. A draft version of the guidelines was published on the ESAIC website for 4 weeks, and the link was distributed to all ESAIC members, both individual and national, encompassing most European national anaesthesia societies. Feedback was gathered and incorporated into the guidelines accordingly. Following the finalisation of the draft, the Guidelines Committee and ESAIC Board officially approved the guidelines.ResultsIn the first phase of the guidelines update, 17 668 titles were initially identified. After removing duplicates and restricting the search period from 1 January 2018 to 3 May 2023, the number of titles was reduced to 16 774, which were then screened, yielding 414 abstracts. Among these, 267 relevant abstracts were identified from which 204 appropriate titles were selected for a comprehensive GRADE analysis. Additionally, the study considered 4 reviews, 16 meta-analyses, 9 previously published guidelines, 58 prospective cohort studies and 83 retrospective studies. The guideline provides 55 evidence-based recommendations that were voted on by a Delphi process, reaching a solid consensus (>90% agreement).DiscussionThis update of the previous guidelines has covered new organisational and clinical aspects of the preoperative anaesthesia assessment to provide a more objective evaluation of patients with a high risk of postoperative complications requiring intensive care. Telemedicine and more predictive preoperative scores and biomarkers should guide the anaesthetist in selecting the appropriate preoperative blood tests, x-rays, and so forth for each patient, allowing the anaesthetist to assess the risks and suggest the most appropriate anaesthetic plan.ConclusionEach patient should have a tailored assessment of their fitness to undergo procedures requiring the involvement of an anaesthetist. The anaesthetist's role is essential in this phase to obtain a broad vision of the patient's clinical conditions, to coordinate care and to help the patient reach an informed decision.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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