In the Netherlands, 16 million inhabitants undergo about 1 million surgical procedures annually. The percentage of serious adverse advents is a burden to society and stresses the need for adequate preoperative assessment in order to select and optimize surgical patients. The clinical course of surgical patients have been the subject of research focusing on perioperative outcome. [1-6]

The influenced time frame expanded from merely improving the direct postoperative surgical outcome to infl uencing the long term outcome of the surgical patient. [7-14]

Consequently, advances in perioperative care emphasize a more important role of the preoperative evaluation and a more comprehensive risk stratifi cation by the anesthesiologist. Recognition and optimization of chronic disease processes prior to surgery could prove benefi cial by reducing the risk of complications, not only in the perioperative stage, but also on longer-term follow up. With the growing number of surgical procedures performed yearly in modern societies we believe anesthesiologists have a golden opportunity to infl uence the health and quality of life of their patients not only during the perioperative phase, but also in order to lower the incidence of long-term adverse outcomes