We recommend that telemedicine and standardised questionnaires be used as part of the preoperative anaesthesia assessment to improve patient accessibility to preanaesthesia care and their satisfaction. (1B)

We suggest performing the preoperative assessment before the day of surgery, preferably within 30 days. However, we advise an updated comprehensive review by the attending anaesthetist within the 48 h before surgery. (CPS)

We suggest conducting the preoperative assessment as early as possible but within 30 days of the planned procedure for high-risk patients, to allow patient optimisation and fitness improvement for surgery. (CPS)

We suggest referral to a specialist (cardiologist, pneumologist, allergologist, etc.) to make an accurate diagnosis and, if the patient’s underlying condition can be improved, to set out a time scale and treatment regimen to obtain this improvement. Only at the end of this process, when the patient is ‘optimised’, can the anaesthetist make a prediction/estimate of the risk. (CPS))

An expert anaesthetist should coordinate the preoperative evaluation involving a multidisciplinary team discussion when needed. (CPS)

We suggest using the Revised Cardiac Risk Index (RCRI) score in preoperative patient risk stratification. (2C)

When ordering preoperative blood tests, we suggest using natriuretic peptides as biological markers in high-risk patients (RCRI >2) undergoing high-risk surgery. (2C)

We discourage using METs as a subjective measurement of the patient’s functional capacity before medical decision-making. The preoperative patient-subjective estimate of METs correlates poorly with the METs measured by exercise stress testing. Nonetheless, in selected individuals, the preoperative assessment of patientsubjective METs is used as a surrogate marker of preoperative performance even if this is not seen as a substitute for preoperative cardiopulmonary testing. (1A)

We recommend combining natriuretic peptides and Duke Activity Status Index questionnaires to evaluate cardiac reserve in high-risk patients undergoing high-risk surgery. (1C)

We recommend completing the WHO Disability Assessment Schedule 2.0 in high-risk patients before surgery as this could be useful to inform the patients about the risks of postoperative disability. (1C)