How can we identify the high-risk patient?

Area of Science:

• Anesthesiology
• Cardiology
• Perioperative Medicine

Background:

• Accurate identification of high-risk surgical patients is essential for optimizing perioperative care.
• Targeted monitoring and interventions can improve outcomes for at-risk individuals.

Purpose of the Study:

• To review current evidence on identifying high-risk surgical patients.
• To explore the utility of preoperative, operative, and postoperative data for risk stratification.

Main Methods:

• Systematic review of existing literature on surgical risk assessment.
• Analysis of data from preoperative, intraoperative, and postoperative periods.

Main Results:

• Preoperative clinical risk indices (e.g., Revised Cardiac Risk Index, ASA Physical Status) and online calculators provide moderate risk estimation.
• Specialized tests (e.g., cardiopulmonary exercise testing, cardiac stress testing) and novel biomarkers (e.g., troponins, natriuretic peptides) can refine preoperative risk assessment.
• Intraoperative and postoperative data, including risk indices (e.g., surgical Apgar score), hypotension, and biomarkers, further inform perioperative risk estimates.

Conclusions:

• Preoperative risk indices and calculators offer moderate accuracy in surgical risk assessment.
• Novel biomarkers, specialized testing, and postoperative indices show potential for refining risk estimates.
• Further research is needed to integrate diverse risk information sources effectively for improved patient management.