Preoperative Assessment

Hepato-pancreatico-biliary (HPB) operations are typically high-risk procedures and can be very morbid, given the risks of significant haemorrhage, vascular and biliary injury. In addition to postoperative complications including infections, biliary and pancreatic leaks, or postoperative liver insufficiency. Mortality for HPB procedures was quite high in the latter-half of the 20th century, but in the current day, mortality is reported to be less than 5%. This trend is certainly multifactorial, with increasingly specialized surgical training programmes, advances in surgical equipment and devices, improvements in patient selection, and more sophisticated and dedicated anaesthesia and care in intensive care units (ICU). Patient selection begins with an understanding of which patients will benefit from surgery, but also includes a better ability to predict which patients will tolerate significant perioperative physiological stress (1). The aim of this chapter is to review the components of a rigorous preoperative assessment to both stratify and mitigate risk in patients undergoing HPB surgery in order to optimize the best outcomes for those patients in need.