A commentary on “Incidence, predictors and validation of risk scores to predict postoperative mortality after noncardiac vascular surgery, a prospective cohort study” (Int J Surg 2020;73:89-93)

Risk score Postoperative adverse outcome Mortality Noncardiac vascular surgery Dear Editor,In a prospective observational cohort study, Reis et al. [1] evaluated the incidence and predictors of 30-day postoperative mortality (POM) after noncardiac vascular surgery and compared the performance of existing risk scores for prediction of POM.By using multivariate analysis, they developed a CAPTA score for prediction of POM and showed that the CAPTA score performed better than the existing risk scores.The research is valuable but there are several issues that we wish to get the authors' comments.First, the study objects were aged 58-82 years, and more than 50% had multiple-comorbidities and polypharmacy.Furthermore, 30-day POM was reported.We would like to know why only postoperative acute myocardial infarction and acute kidney injury were observed.Other than the preoperative health status, comorbidities and intraoperative factors, postoperative adverse events and complications are also important determinants of short-and long-term POM.The available evidence indicates that postoperative pulmonary complications are the major contributors to serious morbidity and mortality after noncardiac surgery, especially for older surgical patients with comorbidities [2] Furthermore, postoperative neurocognitive disorders, stroke, sepsis and deep vein thrombosis have been identified as significant risk factors of POM after noncardiac surgery [3,4].Second, to calculate the Surgical Apgar Score, this study reported minimum heart rate and mean arterial pressure during surgery.It is unclear whether their database contained data on intraoperative hemodynamic instability as intraoperative hypotension has been shown to be significantly associated with increased risks of 30-day POM [5].Third, the multivariable analysis was used to assess the association of clinical variables with POM.In the table 3 of Reis et al' article, some variables such as congestive heart failure, dependent functional status, American Society of Anesthesiology Physical Status classification IV vs. II/III, chronic diuretic medication, postoperative acute myocardial in-Provenance and peer review Commentary, internally reviewed.