ABSTRACT
Surgery can be considered ‘‘controlled trauma’’ that predictably alters the patient’s normal physiology. These physiologic derangements may be more severe, and less well tolerated, in patients with concurrent illnesses such as coronary artery disease or chronic obstructive pulmonary disease (COPD). The potential benefits of an operative procedure must be balanced against the potential risks of the procedure and the risks and benefits of management alternatives. It is imperative that the surgeon be able to recognize those features that may increase a patient’s expected morbidity or mortality and to modify the perioperative management and operative plan accordingly. Just as ‘‘an ounce of prevention is better than a pound of cure,’’ anticipating the patient’s expected clinical course provides a better outcome than reacting to what may have been a preventable complication. An optimal outcome in surgery requires a thoughtful diagnostic workup, careful perioperative care, appropriate surgical procedure, and conscientious follow-up. Preoperative care remains an integral part of surgical care and is the ultimate responsibility of the surgeon. While preparing a patient for surgery may become routine, it is better to understand the physiologic principles involved rather than simply issuing ‘‘standard orders’’ by rote. A thoughtful evaluation based on a thorough knowledge of the natural history of the disease process involved, associated medical conditions, and the physiologic changes produced by them are essential for assessing the risk of treatment options and engaging in appropriate management of the patient’s problems.
