[Preoperative risk assessment in elective visceral surgery. Study design--results--perspectives]

Since 1988 we have been analysing all our patients undergoing elective general surgery with general or spinal anaesthesia in a prospective study, with the aim of identifying and weighing up risk factors. The risk factors have been divided into the following groups: environment, surgeon, anaesthesia, operative intervention, disease and patient, regardless of the current illness. In 1990 a total of 682 patients (mean age 51.6 years, range 14-90), 365 male and 317 female, entered on study. General complications have been recorded in 63 patients (9.2%), whereas local complications occurred in 73 patients (10.7%). The following parameters were identified as risk factors for general complications: age > or = 70 years, hypertensive blood pressure level, haematocrit < 40% (male patients), operative procedure for malignancies, reduced physical capacity, pathologic cardiac or lung history, pathologic ECG, excessive alcohol consumption, hepatosplenomegaly, foreign origin, carotid artery bruit. Five patients died within 30 days following surgery for a malignant disease. This ongoing prospective study is a valuable instrument for the definition of preoperative risk factors in elective general surgery with the objective of eliminating mortality by the end of the century.