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[Comment] The clinical utility of preoperative functional assessment

Nearly 17% of patients undergoing elective surgery have an in-hospital complication, and 0·5% are estimated to die during the admission for surgery.1 With more than 300 million operations occurring per annum, this equates to 50 million complications and 1·5 million deaths annually.2 Preoperative risk assessment is the cornerstone on which subsequent safe surgical care is provided, and functional capacity is entrenched in preoperative cardiovascular assessment. The subjective assessment of functional capacity is a critical decision node in preoperative cardiovascular algorithms,3,4 yet the evidence supporting this practice is limited.