The Concept of Risk Assessment and Being Unfit for Surgery

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Surgical Risk Assessment

Background:

• The increasing complexity and volume of minimally invasive vascular surgery necessitate improved patient selection.
• Current definitions of surgical unfitness and high-risk criteria for vascular procedures are not standardized or consistently updated.
• Existing predictive risk scores often lack generalizability due to gaps in defining high-risk vascular patients.

Purpose of the Study:

• To propose a practical, step-by-step approach for assessing surgical risk in vascular interventions.
• To highlight the need for updated, objective definitions of surgical unfitness in the evolving field of vascular surgery.
• To emphasize the importance of incorporating frailty and geriatric assessments into surgical risk stratification.

Main Methods:

• A review of current concepts in surgical risk assessment for vascular interventions.
• A proposed three-step, two-point approach for defining, quantifying, and stratifying surgical risk.
• Inclusion of patient-specific factors like life expectancy, goals, and geriatric burden (frailty, cognitive, functional, social, nutritional status).

Main Results:

• A structured, step-by-step process for identifying and stratifying high-risk vascular surgery patients is outlined.
• The review identifies significant gaps in the current literature regarding standardized definitions of surgical unfitness.
• Traditional high-risk criteria are evolving, necessitating a broader assessment beyond peri-operative mortality.

Conclusions:

• A more refined, multi-faceted approach to surgical risk assessment is crucial for vascular interventions, especially in elderly and complex patients.
• Integrating geriatric assessments and patient-centered goals is essential for accurate risk stratification and informed surgical decisions.
• Standardized definitions and validated predictive tools are needed to improve patient selection and outcomes in vascular surgery.