Assessment of the high-risk perioperative patient

摘要

Every year, 234 million people worldwide have surgery requiring an inpatient stay. In developed countries, the rate of permanent disability or death after such procedures is between 0.4 and 0.8%. However, within this population is hidden a subgroup of high-risk patients: in the UK 12.5% of patients account for 80% of perioperative deaths.1 The short-term postoperative mortality for this high-risk group is estimated at ~6% for elective patients and close to 30% for those having urgent or emergency surgery.1 Several perioperative interventions are available to mitigate against adverse outcomes. These include targeted exercise ('prehabilitation'), optimization of fluid and inotrope therapy, selection of surgical and anaesthetic personnel of appropriate seniority, and appropriate use of critical care facilities. However, allocation of such resources relies on recognition of 'at risk' patients; several recent reports have highlighted deficiencies in this process.