As the population ages, an increasing number of elderly patients will need surgery. An organized medical evaluation that focuses on the patient's cardiopulmonary and nutritional status should be performed before the patient undergoes surgery. The initial history and physical examination should be performed up to 8 weeks before surgery. Follow-up examinations are then dictated by the results of the initial examination. Established guidelines to assess cardiopulmonary and nutritional status should be followed. Preoperative laboratory assessment should consist of hemoglobin and creatinine measurements and include a urinalysis and electrocardiogram. The need for additional tests is indicated by the history and physical examination. Following this assessment, therapeutic and prophylactic measures to reduce surgical morbidity and mortality can be implemented. With timely identification and management of medical disease in geriatric surgical patients, the risks of surgery can be minimized.