ASCRS Ch06 — Preoperative Evaluation in Colorectal Patients

Citation: Landmann RG, Francone TD. "Preoperative Evaluation in Colorectal Patients." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. (PDF pp. 109–134 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF).

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Sixth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers routine preoperative evaluation and testing; cardiac risk assessment (RCRI, functional capacity/METs, medical optimization); preoperative anticoagulation management (warfarin, DOACs, coronary stents, bridging, prosthetic valves, AICD/pacemakers); pulmonary assessment (COPD, smoking cessation, OSA); perioperative steroid management and the stress-dose-steroid controversy; diabetes; obesity; malnutrition/sarcopenia; solid organ transplant recipients; substance abuse; immunosuppressive agents/biologics/chemotherapy and anastomotic-healing risk; preoperative assessment in the elderly (frailty models, cognitive dysfunction/delirium); and prehabilitation.

Key content

Full synthesis written into the new concept page Preoperative Evaluation & Perioperative Risk Optimization rather than summarized twice here. Substantially extends existing wiki content rather than duplicating it: adds a framing-difference flag to Crohn Disease's existing BSG-guideline perioperative-optimization section (same PUCCINI finding, presented here alongside a messier, self-described "quite conflicting and controversial" literature); quantifies Diverticulitis's brief immunocompromised-patient bullet (40% emergent-op rate, 6.9% mortality) and adds a practice-changing finding (prophylactic colectomy not recommended in immunosuppressed quiescent disease); quantifies Total Neoadjuvant Therapy (TNT)'s bevacizumab healing-risk mention (OR 2.85 for anastomotic leak, 9-week median hold interval); and extends Ileal Pouch-Anal Anastomosis (IPAA)'s obesity/reach-difficulty content with obesity's independent effect on pouch-anal leak rate.

Limitations

• Textbook chapter, not primary literature; cites but does not independently verify most of the trial/series figures given for cardiac risk, anticoagulation bridging, and anastomotic-healing risk.
• The chapter's own framing of the biologics/anastomotic-healing literature is explicitly self-described as "quite conflicting and controversial" — this uncertainty is preserved rather than resolved, consistent with wiki convention of flagging rather than silently merging discrepant framings.
• Frailty-assessment tool comparisons (Hopkins Frailty Score, mFI, RAI) and prehabilitation outcome data (including a null-result RCT in frail patients) are presented largely as the chapter authors summarize them, without independent effect-size verification.

Relevance

Sixth entry in the ASCRS ingest. A broad perioperative-risk-optimization chapter that touches many existing condition/procedure pages without duplicating them — a strong example of the ingest's de-duplication approach: four existing pages (Crohn Disease, Diverticulitis, Total Neoadjuvant Therapy (TNT), Ileal Pouch-Anal Anastomosis (IPAA)) were extended with quantified detail or cross-references rather than restated, and one genuine framing difference (biologics/anastomotic-healing evidence confidence) was flagged rather than resolved.