Operative Risk

Excerpt

One of the main challenges in surgery has long been to develop safe, effective, and technically feasible procedures to achieve the best possible outcomes. Continuous progress in science and technology, combined with cumulative experience in the field, has refined indications for surgical treatment, standardized modern surgical techniques, and established comprehensive protocols for perioperative care. The most complex interventions can now be implemented with significantly reduced intraoperative trauma by using modern instruments and minimally invasive approaches. Surgical procedures have become faster and safer, but complications remain prevalent, even in experienced hands.

Surgeons are challenged by another conundrum: to select the best candidates for surgical treatment accurately. While the technical aspects of surgery remain crucial, accurate prediction of immediate and long-term outcomes is an important part of an elective procedure that guides preoperative testing. Failure to identify patients at a high operative risk may be associated with inappropriate postoperative care and a significant increase in in-hospital mortality. Preoperative risk factors and surgical complexity are predictive of treatment costs. Also, operative risk serves as a solid foundation for a future patient-surgeon relationship. Having the same understanding of the goals of surgical treatment and realistic expectations for postoperative recovery and possible complications is important for shared decision-making.

The selection of patients for surgical treatment is still largely influenced by a surgeon’s personal experience and judgment. However, estimating an individual risk-to-benefit ratio for a specific surgical procedure can help objectively adopt a nonoperative management strategy or select the best surgical procedure at the most appropriate time. This article aims to discuss operative risk, review common risk factors and available statistical models for predicting adverse events after surgery, and speculate on practical aspects of operative risk assessment.