Preoperative Clinics: Do We Still Need Them? Reframing the Preoperative Period as a Treatment Window

Abstract

Abstract Purpose of Review This review examines whether the traditional preoperative assessment clinic, designed primarily to reduce perioperative complications, improve patient safety, and prevent day-of-surgery cancellations, remains the appropriate model for perioperative care, and evaluates the evidence for a shift from preoperative evaluation to preoperative optimization. Recent Findings Virtual preoperative evaluation is non-inferior to in-person evaluation for cancellation prevention and patient satisfaction, but neither format addresses the underlying limitation of assessment without optimization. Screening programs organized around modifiable risk factors are achievable in routine practice, though compliance with optimization remains low without structured follow-through. Preoperative correction of anemia, hyperglycemia, impaired functional capacity, and tobacco use improves surgical outcomes. Summary A tiered perioperative optimization pathway, combining universal virtual screening, modular specialist-led optimization, and anesthesiologist-coordinated planning for high-risk patients, offers a more clinically meaningful model than either traditional or virtual preoperative clinics. This framework treats the preoperative period as a treatment window rather than an administrative checkpoint.