High perioperative risk patients: two approaches to stratification. Review

Despite the successes of modern medicine, surgical interventions have not become absolutely safe, so far the prevalence of postoperative complications and mortality remain high, and postoperative mortality came in third place among the causes of death after coronary heart disease and stroke. The problem of perioperative risk assessment constantly attracts the attention of specialists, since the identification of high-risk patients is the basis for the prevention of an adverse outcome. Nevertheless, despite its importance, the problem is far from being solved. This review focuses on two approaches to risk stratification: mortality risk assessment and complications risk assessment. The analysis of the literature shows how contradictory both these approaches are: the absence of generally accepted definitions of mortality and complications, the diversity of criteria for the allocation of high risk — all these leads to the absence of a single idea of high perioperative risk. Current risk assessment systems have significant limitations and low predictive value. Nevertheless, there has been progress in the standardization of risk stratification studies over the past decade: common definitions are emerging, national registers are being created — all this gives hope for improving the quality of the risk assessment.