Defining higher-risk surgery

Ackland, Gareth L and Edwards, Mark (2010) Defining higher-risk surgery. Current Opinion in Critical Care, 16 (4), 339-346. (doi:10.1097/MCC.0b013e328339fad5).

Abstract

PURPOSE OF REVIEW: Defining the contemporary high-risk noncardiac surgical population using objective clinical outcomes data is paramount for the rational allocation of healthcare resources, truly informed patient consent and improving patient-centered outcomes.

RECENT FINDINGS: Data from independent healthcare systems have identified that the development, and consequences, of postoperative morbidity extend beyond the immediate postoperative hospital period and confer substantially increased risk of death. Cardiac insufficiency, rather than the relatively heavily explored paradigm of perioperative cardiac ischemia, is emerging as the dominant factor associated with excess risk of prolonged postoperative morbidity. The development of prospective, validated, time-sensitive morbidity data collection tools has also helped define patients at higher risk of noncardiac morbidities and short-term perioperative outcomes.

SUMMARY: Higher risk surgical patients present an increasingly major challenge for healthcare resource utilization. Detailed outcome studies using validated morbidity tools are urgently required to establish the extent to which postoperative morbidity may be predicted. Robust identification of patients at the highest risk of perioperative morbidity may permit further clinic-to-bench translational understanding of the pathophysiologic mechanisms underlying postoperative organ dysfunction. Defining the high-risk surgical patient population is as critically important for global public health planning as it is for the perioperative team.

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