Summary The evaluation of the patient’s medical history and physical examination are the cornerstones of risk assessment prior to elective surgery. They may help to optimize the patient’s preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) may contribute to a reduction of peri­operative risk, is often not very well known or controversial. Similarly, there is considerable uncertainty among anaes­‑ thesiologists, internists and surgeons with respect to the perioperative man- a­gement of the patient’s chronic medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Me­dicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non cardiac and non lung-resecting surgery. In the first part, the general principles of preoperative evaluation are described (Part A). The current concepts for extend-ed evaluation of patients with known or suspected major cardiovascular dis­‑ ease are indicated in Part B. Finally, the perioperative management of the patient’s chronic medication is discussed (Part C). The concepts proposed in this interdisciplinary recommendation con­‑ sented by both DGAI, DGCH and DGIM provide a common basis for a structured preoperative risk assessment and management. Thereby, this recommendation aims to make sure that (1) surgical patients undergo a rational preoperative work-up and, at the same time, (2) to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect our current knowledge based on the available scientific evidence as well as expert opinion, if evidence was lacking, and will be subject to regular re-evaluation.