Key Concepts

• Patients undergoing elective abdominal colorectal operations are in the “intermediate” risk group for perioperative morbidity and mortality.
• Recognition and optimization of concomitant patient pathophysiology are paramount in minimizing sepsis (anastomotic leak, surgical site infection), complications, and overall morbidity.
• These include cardiopulmonary, renal, metabolic, and endocrine physiology and other pathophysiologic risk factors and derangements (such as frailty and immunosuppression).
• Implementation of ACC/AHA guidelines and evidence-based medical management leads to improved efficiencies with minimization of extraneous testing and delays, while preserving low complication rates.
• Corticosteroids and immunosuppression remain significant determinants of morbidity in patients undergoing intestinal colorectal surgery.
• Prehabilitation of the frail and elderly patient is critical in optimizing patients for surgery while attempting to mitigate perioperative morbidity and mortality.