Background and Objective: High-risk patient cohorts have significant rates of morbidity and mortality following thoracic surgery, these outcomes can be modulated with preoperative intervention. This review article examines the existing literature pertaining to specific high-risk groups of patients and the impact of preoperative optimisation.Methods: We performed literature searches using the PubMed and BMJ search engine for Englishlanguage articles published from 1966 to 2022. A separate literature search was performed for each individual topic area to identify existing evidence of optimisation and the magnitude of effect. Key recommendations were compiled for each topic area.