How to identify a high-risk surgical patient?

How to identify a high-risk surgical patient?The number of surgical procedures continues to grow globally and there is a clear need to increase the availability of safe, timely, and affordable surgery, especially in constrained resources scenarios. 1As overall life expectancy continues to increase, it is more common to offer complex procedures to patients displaying advanced age and serious comorbidities, with inevitable increases in morbidity and mortality after surgery despite the most recent technological advances in anesthetic care.Although both postoperative morbidity and mortality vary significantly among patients, it is particularly higher in a vulnerable group of high-risk patients.Therefore, accurate preoperative identification of high-risk patients is strongly recommended.Risk stratification and early recognition of high-risk patients may improve outcomes since it facilitates surgical decision-making, preoperative optimization, and tailored intraoperative and postoperative management. 2 However, in order to enhance patient care, risk stratification tools should be validated to the target populations it will be applied, and should be easily applicable at the bedside.Ultimately, risk stratification needs to encompass the complex interaction between surgical and anesthetic procedures and patient specific features to be able to assess postoperative morbidity and mortality in different moments, including the preoperative, intra-operative, and postoperative periods. 3,4lenty of surgical risk models have been developed and investigated.American Society of Anesthesiologists' Physical Status (ASA-PS) classification, Revised Cardiac Risk Index (RCRI), American College of Surgeons' National Surgical Quality Improvement Program Risk Calculators (ACS-NSQIP), and the Surgical Outcome Risk Tool (SORT) model are some of the most commonly used preoperative scoring systems.ASA-PS classification is the simplest scoring system and has been used since 1941. 5Risk assignment is independent of the surgical procedure and is based solely on subjective assessment of a patients' overall health status, leading to significant inter-rater reliability.The RCRI was designed to focus on major cardiovascular mortality following noncardiac surgeries, consisting of six independent predictors: high-risk surgery, history of ischemic heart disease,