Preoperative anaesthesia assessment (PAA) is a vital component of surgical care aimed at identifying and minimizing perioperative risks through systematic evaluation of a patient’s medical status, functional capacity, and anaesthetic concerns (1). The assessment allows for optimization of comorbidities, risk stratification, and planning of both anaesthetic technique and postoperative care, ultimately contributing to improved surgical outcomes and patient safety (2,3).

In elective surgeries, PAA is routinely performed well in advance, offering ample time for thorough evaluation, investigations, and optimization of the patient’s physical condition (4). Conversely, emergency surgical procedures often pose challenges in conducting a complete PAA due to time constraints, limited preoperative preparation, and the urgency of intervention. This frequently leads to higher perioperative risks, increased rates of postoperative complications, and poorer overall outcomes (5,6).

Studies have shown that inadequate preoperative evaluation in emergency settings correlates with higher rates of anaesthesia-related adverse events, such as hemodynamic instability, respiratory complications, and extended hospital stays (7). Moreover, the American Society of Anesthesiologists (ASA) physical status classification is a widely accepted tool used during PAA to predict perioperative risks, with higher ASA scores being directly associated with worse outcomes (8).

Despite the critical importance of PAA, limited data exists comparing its impact across elective and emergency surgical settings, especially in resource-limited healthcare systems. This study aims to assess the influence of preoperative anaesthesia evaluations on surgical outcomes and complication rates in patients undergoing emergency versus elective surgeries.

This prospective observational study was conducted over a 12-month period in the departments of surgery and anaesthesiology at Travancore Medical College, Kollam, Kerala. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all participants or their legal representatives.

A total of 200 adult patients (aged 18 years and above) scheduled for surgery under general or regional anaesthesia were enrolled and divided into two equal groups. Group A (n = 100) included patients undergoing elective surgeries with complete preoperative anaesthesia assessment, while Group B (n = 100) comprised patients undergoing emergency surgeries where time-limited or expedited assessments were conducted.

The preoperative assessment in Group A included a detailed medical history, physical examination, relevant investigations (blood tests, ECG, chest X-ray, etc.), ASA classification, and anaesthetic planning. In contrast, Group B patients received a focused evaluation based on the urgency of surgery, vital signs, and available laboratory reports.

Data collected included demographic information (age, sex), ASA physical status, type and duration of surgery, intraoperative events (such as hypotension, desaturation, or arrhythmia), postoperative complications (infection, delayed recovery, etc.), need for ICU admission, and 30-day postoperative mortality.

The outcomes of both groups were compared using statistical software (SPSS version 25.0). Categorical variables were analyzed using the Chi-square test or Fisher’s exact test, while continuous variables were evaluated using the Student’s t-test or Mann–Whitney U test based on data distribution. A p-value less than 0.05 was considered statistically significant.

A total of 200 patients were analyzed, with 100 in the elective surgery group (Group A) and 100 in the emergency surgery group (Group B). The mean age of patients in Group A was 45.6 ± 12.3 years, whereas in Group B, it was 47.8 ± 14.1 years. There was no statistically significant difference in age and gender distribution between the groups (p > 0.05).

The comparison of intraoperative complications, postoperative outcomes, ICU admissions, and 30-day mortality between the two groups is presented in Table 1.

Table 1: Comparison of Surgical Outcomes between Elective (Group A) and Emergency (Group B) Surgeries

* Statistically significant

As shown in Table 1, patients in the emergency group (Group B) had a significantly higher incidence of intraoperative complications (18%) compared to the elective group (6%). Similarly, postoperative infections were more common in Group B (12%) than in Group A (4%). ICU admission rates were higher in Group B (10%) versus Group A (3%), and the 30-day mortality rate was significantly elevated in the emergency group (7%) compared to the elective group (2%).

These findings indicate that a thorough preoperative anaesthesia assessment is associated with reduced complications and better surgical outcomes.

The present study highlights the significant role of preoperative anaesthesia assessment (PAA) in improving surgical outcomes and reducing complication rates, particularly when comparing elective and emergency procedures. Our findings indicate that comprehensive preoperative evaluation significantly lowers the incidence of intraoperative complications, postoperative infections, ICU admissions, and 30-day mortality rates.

Preoperative anaesthesia assessments are structured evaluations that aim to identify modifiable risk factors, optimize existing medical conditions, and formulate an individualized perioperative management plan (1,2). In elective surgeries, such assessments are typically performed days in advance, allowing sufficient time for medical optimization, patient counseling, and coordination of multidisciplinary care (3,4). This preparatory advantage is reflected in the lower complication and mortality rates observed in Group A of this study.

In contrast, emergency surgeries often demand urgent intervention, restricting the time available for thorough assessment. Consequently, decisions are frequently made based on limited clinical data, increasing the risk of anaesthetic complications and poor outcomes (5,6). The higher ASA III–IV proportion in the emergency group further supports the increased perioperative risk in such scenarios. ASA physical status classification, a widely accepted indicator of surgical risk, has been shown to be a strong predictor of perioperative morbidity and mortality (7,8).

Our findings align with earlier studies that emphasize the protective role of PAAs. Van Klei et al. observed a significant reduction in surgical cancellations and complications with structured preoperative clinics (9). Similarly, Salzwedel et al. reported a decrease in perioperative adverse events following the implementation of preoperative checklists (10). These structured assessments not only enhance patient safety but also contribute to efficient resource utilization and improved hospital workflow.

Furthermore, the observed increase in ICU admissions and postoperative infections in emergency cases supports existing evidence that inadequate preoperative planning correlates with higher postoperative care requirements (11,12). Gonzalez et al. demonstrated that emergency departments equipped with rapid preoperative evaluation protocols witnessed a decline in OR delays and postoperative complications (13).

While emergency surgeries cannot always benefit from the extensive workup typical of elective procedures, establishing a focused yet rapid assessment model may bridge this gap. Modified protocols emphasizing vital signs, ASA grading, focused history, and rapid diagnostics have shown promising results in mitigating perioperative risks (14).

Nonetheless, it is essential to acknowledge the limitations of this study. Being a single-center study with a relatively small sample size, the results may not be generalizable across different healthcare settings. Additionally, emergency surgeries encompass a broad spectrum of cases, making uniform comparison challenging. Future research involving multicentric data and larger patient populations is needed to validate these observations and develop standardized rapid-assessment protocols for emergency care.

In conclusion, the results of this study reinforce the critical importance of preoperative anaesthesia assessment in surgical practice. Strengthening rapid yet structured assessment protocols in emergency settings may significantly enhance patient outcomes and reduce the burden of postoperative complications.

1. Teja B, Bosch NA, Diep C, Pereira TV, Mauricio P, Sklar MC, et al. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2024;184(5):474–82. doi:10.1001/jamainternmed.2023.8232.
2. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1–165. doi:10.1007/s10029-017-1668-x.
3. Gartenberg A, Nessim A, Cho W. Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment. Eur Spine J. 2021;30(10):2936–43. doi:10.1007/s00586-021-06927-9.
4. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev. 2022;4(4):CD011136. doi:10.1002/14651858.CD011136.pub3.
5. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–31. doi:10.1093/bja/aer058.
6. Doleman B, Fonnes S, Lund JN, Boyd-Carson H, Javanmard-Emamghissi H, Moug S, et al. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev. 2024;4(4):CD015038. doi:10.1002/14651858.CD015038.pub2.
7. Bissonnette B, Sullivan PJ. Pyloric stenosis. Can J Anaesth. 1991;38(5):668–76. doi:10.1007/BF03008206.
8. Torossian A, Bräuer A, Höcker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int. 2015;112(10):166–72. doi:10.3238/arztebl.2015.0166.
9. Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, et al. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024;280(6):945–53. doi:10.1097/SLA.0000000000006339.
10. Smetana GW, Lawrence VA, Cornell JE; American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581–95. doi:10.7326/0003-4819-144-8-200604180-00009.
11. Grandin EW, Nunez JI, Willar B, Kennedy K, Rycus P, Tonna JE, et al. Mechanical Left Ventricular Unloading in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation. J Am Coll Cardiol. 2022;79(13):1239–50. doi:10.1016/j.jacc.2022.01.032.
12. Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, et al. Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med. 2020;46(12):2464–76. doi:10.1007/s00134-020-06290-1.
13. Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth. 2021;68(9):1373–404. doi:10.1007/s12630-021-02007-0.
14. Park DK, Weng C, Zakko P, Choi DJ. Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation. JBJS Essent Surg Tech. 2023;13(2):e22.00020. doi:10.2106/JBJS.ST.22.00020.
15. Goldsmith A, Driver L, Duggan NM, Riscinti M, Martin D, Heffler M, et al. Complication Rates After Ultrasonography-Guided Nerve Blocks Performed in the Emergency Department. JAMA Netw Open. 2024;7(11):e2444742. doi:10.1001/jamanetworkopen.2024.44742.