CONGRESS ABSTRACT

Introduction The implementation of structured pathways for outpatient preoperative assessment is a critical advancement in perioperative medicine, aiming to improve patient safety, optimize resource allocation, and enhance clinical outcomes. The paper describes development and deployment of a cardiac preoperative assessment pathway in non cardiac surgery at Varese Hospital (Ospedale di Circolo Varese ASST Settelaghi). Materials and Methods The pathway integrates validated scoring systems such as the American Society of Anesthesiologists (ASA) Physical Status Classification, Revised Cardiac Risk Index (RCRI), and Duke Activity Status Index (DASI), alongside clinical examinations. These tools are applied through a stepwise evaluation process tailored to the type of planned surgery. Cardiologists and anesthesiologists, within the outpatient preoperative setting, determine necessary cardiac exams in accordance with national and international guidelines. A key element of the pathway’s success is the collaboration of multidisciplinary teams—including anesthesiologists, surgeons and cardiologists—to ensure accurate preoperative evaluations aligned with surgical indications (elective or time-sensitive). A dedicated Preoperative Assessment Hub, where anesthesiologic and cardiac evaluations are conducted, was established. Cardiologists perform an “on-desk evaluation” by reviewing anesthesiological and surgical medical records to finalize clinical recommendations or schedule comprehensive patient assessments for clinical and instrumental evaluations. Then anesthesiologists review the completed medical records and provide the final judgment of surgical suitability based on cardiologists' recommendations. Results The pathway is detailed in Figure 1. Discussion and Conclusion The development of a structured preoperative assessment pathway, with emphasis on cardiac evaluation, represents a transformative approach to perioperative care. In accordance with national and international recommendations, the inclusion of cardiology "on-desk evaluation" significantly enhances shared decision-making, reduces time to surgery and avoids unnecessary preoperative cardiology visits. However, the innovative nature of this approach and the current lack of supporting data represent its primary limitations. Future research will focus on evaluating the pathway's impact on patient outcomes and its cost-effectiveness in perioperative care.