Optimal postoperative outcomes begin before surgery with what has been called “perioperative optimization.”22 This process begins with evaluation of patients preoperatively for postoperative morbidity and mortality risk factors, such as organ dysfunction and malnutrition, which can prolong the surgical stress response and increase the likelihood of complications. Steps are taken to correct deficiencies and optimize patient health before surgery. For example, measures are taken to maximize pulmonary function, ensure adequate hydration and nutritional status, control chronic pain, and identify and reduce the use of alcohol, tobacco, and medications that may produce adverse intraoperative and postoperative events