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How to better identify patients at high risk of postoperative complications?

Talmor, Daniel; Kelly, Barry

Current Opinion in Critical Care: October 2017 - Volume 23 - Issue 5 - p 417–423
doi: 10.1097/MCC.0000000000000445
POSTOPERATIVE PROBLEMS: Edited by Samir Jaber

Purpose of review Preoperative risk assessment and perioperative factors may help identify patients at increased risk of postoperative complications and allow postoperative management strategies that improve patient outcomes. This review summarizes historical and more recent scoring systems for predicting patients with increased morbidity and mortality in the postoperative period.

Recent findings Most prediction scores predict postoperative mortality with, at best, moderate accuracy. Scores that incorporate surgery-specific and intraoperative covariates may improve the accuracy of traditional scores. Traditional risk factors including increased ASA physical status score, emergent surgery, intraoperative blood loss and hemodynamic instability are consistently associated with increased mortality using most scoring systems.

Summary Preoperative clinical risk indices and risk calculators estimate surgical risk with moderate accuracy. Surgery-specific risk calculators are helpful in identifying patients at increased risk of 30-day mortality. Particular attention should be paid to intraoperative hemodynamic instability, blood loss, extent of surgical excision and volume of resection.

Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachussets, USA

Correspondence to Daniel Talmor, MD, MPH, Edward Lowenstein Professor and Chair, Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Yamins 219, 330 Brookline Avenue, Boston, MA 02215, USA. Tel: +1 617 667 2902; fax: +1 617 667 5013; e-mail: dtalmor@bidmc.harvard.edu

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