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Guidelines on perioperative cardiovascular evaluation for noncardiac surgery have been published. The integration of clinical risk factors, surgery-specific risk,and functional capacity should be used to determine the need for further diagnostic evaluation. The use of beta-adrenergic blockade in high-risk patients,particularly those with documented myocardium at risk undergoing vascular surgery, has been shown to reduce perioperative risk and may obviate the need for more invasive procedures. Coronary intervention should be reserved for those patients who warrant intervention independent of the noncardiac surgery.

An increasing number of surgical procedures are now performed on an ambulatory basis. This article reviews these conditions and defines the appropriate preoperative evaluation and perioperative management. Our goal is to define those patients who would benefit in having care in an inpatient setting or those who require more intensive medical evaluation or preparation prior to outpatient surgery.