Personalized approach to preoperative strategy: from risk prediction to reasoned action

Perioperative medicine is confronted with an increasing complexification of patient profiles and care pathways, rendering standardized approaches less and less relevant. While risk stratification tools today make it possible to identify patients and procedures at risk, their capacity to guide truly individualized decisions remains limited. The current challenge is no longer limited to the prediction of complications, but to the reasoned and personalized adaptation of the preoperative strategy.
This approach is based on three complementary pillars: (1) a dynamic risk stratification integrating biomarkers, targeted imaging and functional assessment; (2) an individualized prehabilitation, taking into account patient capacities and time constraints; and (3) a reasoned management of treatments, particularly cardiovascular and metabolic, based on a balanced assessment of risks.
It implies a requirement for the relevance of preoperative prescriptions, integrating cost-effectiveness and ecological impact considerations, by limiting the use of predictive tests without expected therapeutic consequences.
The individualization of the preoperative phase furthermore conditions the choice of the level and modalities of intra- and postoperative monitoring, including hemodynamic monitoring, sedation and the organization of the postoperative pathway. It is part of an approach of informed information and shared decision-making with the patient.
Thus, beyond the sole assessment of risk, this approach aims to optimize the perioperative pathway and to improve the prognosis of surgical patients.