Preoperative clinical risk indices, novel biomarkers like troponins and natriuretic peptides, and specialized testing estimate surgical risk with moderate accuracy to identify high-risk patients.
How can high-risk surgical patients be accurately identified using perioperative clinical information, tests, and biomarkers?
This review highlights that while simple clinical indices provide moderate accuracy for perioperative risk estimation, integrating novel biomarkers and specialized testing may further refine risk stratification.
PURPOSE OF REVIEW: Accurate and early identification of high-risk surgical patients allows for targeted use of perioperative monitoring and interventions that may improve their outcomes. This review summarizes current evidence on how information from the preoperative, operative, and immediate postoperative periods can help identify such individuals. RECENT FINDINGS: Simple risk indices, such as the Revised Cardiac Risk Index or American Society of Anesthesiologists Physical Status scale, and online calculators allow risk to be estimated with moderate accuracy using readily available preoperative clinical information. Both specific specialized tests (i.e., cardiopulmonary exercise testing and cardiac stress testing) and promising novel biomarkers (i.e., troponins and natriuretic peptides) can help refine these risk estimates before surgery. Estimates of perioperative risk can be further informed by information acquired during the operative and immediate postoperative periods, such as risk indices (i.e., surgical Apgar score), individual risk factors (i.e., intraoperative hypotension), or postoperative biomarkers (i.e., troponins and natriuretic peptides). SUMMARY: Preoperative clinical risk indices and risk calculators estimate surgical risk with moderate accuracy. Although novel biomarkers, specialized preoperative testing, and immediate postoperative risk indices show promise as methods to refine these risk estimates, more research is needed on how best to integrate risk information from these different sources.
Sankar et al. (Wed,) conducted a review in Perioperative risk in surgical patients. Perioperative risk assessment tools (clinical indices, biomarkers, specialized testing) was evaluated. Preoperative clinical risk indices, novel biomarkers like troponins and natriuretic peptides, and specialized testing estimate surgical risk with moderate accuracy to identify high-risk patients.