Patients ages 40 and older are at increased risk for postoperative complications but are often under-optimized preoperatively due to a lack of proper screening tools. The clinical question for this project was: In patients ages forty and older undergoing elective Otolaryngology (ENT) procedures, how does the use of a preoperative risk assessment tool compared to standard preoperative care influence the rate of same-day surgical case cancellations due to improper preoperative optimization? A pre- and post-implementation design was conducted at an academic medical center with ENT surgical cases. The primary outcome was the rate of same-day anesthesia-led cancellations. Eligible cases included patients forty and older undergoing elective procedures scheduled at least five days prior to surgery. The National Institute for Health and Care Excellence (NICE) tool was implemented preoperatively as patients were assessed by the team leaders. NICE tool recommendations were documented and reviewed by a Certified Registered Nurse Anesthetist (CRNA). The CRNA forwarded the recommendations to the ENT service. Data was collected for five weeks pre-implementation (n=107) and four weeks post-implementation of the NICE tool (n=109) to determine if cases were cancelled. Pre-implementation same-day anesthesia-led cancellation rate was 4.67%; post-implementation, the same-day anesthesia-led cancellation rate was 8.4%. Cancellations had no association with NICE tool implementation (χ2(1) = 1.144, p = 0.285).