We do not recommend routine noninvasive testing for cardiovascular risk stratification prior to elective adult non-cardiac surgery（Evidence level:low and moderate；Recommendation grade:strong）.

We suggest that all elective non-cardiac surgical patients 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure; or patients 18 years or older with peripheral vascular disease undergoing vascular surgery require further preoperative risk stratification as their predicted 30-day MACE risk >5%. This recommendation does not apply to patients undergoing low risk surgery, and surgery which does not require overnight hospital admission.（Evidence level:moderate；Recommendation grade:conditional recommendation）.

Preoperative exercise rehabilitation plans can reduce hospital hospitalization time and postoperative pulmonary complications. Due to the heterogeneity of research, there is no clear recommendation on the nature of intervention in terms of exercise type, mode, frequency, or preoperative duration. Rehabilitation treatment should be considered for patients with poor lung function or motor ability.（Evidence level:low；Recommendation grade:strong）.

Alcohol is related to the increase of perioperative incidence rate and mortality. Patients who abuse alcohol should avoid drinking at least 4 weeks before surgery.（Evidence level:moderate；Recommendation grade:strong）.

Smoking is associated with an increased risk of postoperative morbidity (especially pulmonary complications) and mortality and ideally should be stopped at least 4 weeks before surgery.（Evidence level:high；Recommendation grade:strong）.

Patients should routinely receive dedicated preoperative counselling.（Evidence level:low；Recommendation grade:conditional recommendation）.

Patients taking β-blockers preoperatively should continue to take them in the postoperative period to prevent postoperative atrial fibrillation and flutter (POAF）secondary to acute withdrawal（Evidence level:High；Recommendation grade: Strong）. Magnesium supplementation may be considered in magnesium deplete patients（Evidence level:Low；Recommendation grade: Week）. The administration of diltiazem preoperatively or amiodarone postoperatively is reasonable in patients deemed at high risk, although there is little evidence that POAF prophylaxis improves outcomes（Evidence level:Moderate；Recommendation grade: Week）.

Routine administration of sedatives to reduce anxiety preoperatively should be avoided to hasten postoperative recovery. Alternative non-pharmacological methods to relieve preoperative anxiety should be considered in patients with severe anxiety（Evidence level: Moderate；Recommendation grade:Strong）.

Anemia before operation is related to the increase of incidence rate and mortality after operation, which should be checked and corrected before operation. Iron therapy is the first line of treatment for correcting iron deficiency anemia. When possible, blood transfusions or erythropoietic drugs should not be used to correct preoperative anemia（Evidence level:High；Recommendation grade: Strong）

Patients should be screened for nutritional status and weight loss before surgery. If there is a risk, active nutritional support should be provided（Evidence level：high ; Recommendation grade： Strong）. Oral nutritional supplements can be used to supplement total intake（Evidence level：Moderate ; Recommendation grade： Strong ）. There is not enough evidence to recommend preoperative immune enhanced nutrition (IEN) as superior to nutritional supplements, but it may play a role in postoperative malnutrition patientsEvidence level：low ; Recommendation grade：weak）