Selective preoperative assessment before early laparoscopic cholecystectomy: A narrative review

Table 5 Practical recommendations and evidence of strength

Recommendation	Suggested approach	Strength of rationale
Direct listing for selected low-risk patients	ASA I-II, no red flags, recent investigations reviewed, same-day anaesthetic confirmation	Moderate; supported by indirect evidence and service experience
Formal assessment for higher-risk patients	ASA III-IV, frailty, unstable systemic disease, complex medications or airway concerns	Strong; consistent with perioperative medicine principles
Do not rely on ASA alone	Add comorbidity, frailty, functional capacity and medication review	Strong; ASA limitations are well documented
Prospective audit	Track clinical, operational, economic and patient-reported outcomes	Essential for governance and generalisability
Digital triage with oversight	Use electronic questionnaires and EPR integration; retain clinician review	Emerging; promising but requires validation

ASA: American Society of Anesthesiologists; EPR: Enterprise resource planning.