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Abstract

The definition of risk in surgical patients is a complex and controversial area. Generally risk is poorly understood and depends on past individual and professional perception, and societal norms. In medical use the situation is further complicated by practical considerations of the ease with which risk can be measured; and this seems to have driven much risk assessment work, with a focus on objective measurements of cardiac function. The usefulness of risk assessment and the definition of risk is however in doubt because there are very few studies that have materially altered patient outcome based on information gained by risk assessment. This paper discusses these issues, highlights areas where more research could usefully be performed, and by defining limits for high surgical risk, suggests a practical approach to the assessment of risk using risk assessment tools.

Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

“…[910] The overall mortality rate was 5 out of 24 patients (20.8%), with only two postprocedural death (8.3%) that seem to be clearly less than those in conventional surgery[13] with the same high risk groups. Many studies traced the mortality rate in such patients subjected to conventional surgery and could predict postoperative death with 87% accuracy.…”

Clinical review: Goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups

“…Morbidity, expressed as number of patients with complications, was the secondary outcome. Mortality risk groups were based on the definition of the high-risk surgical patient by Boyd and Jackson, such that patients whose risk of mortality was 5 to 19% and ≥20% were classified as high-risk and extremely high-risk, respectively [9]. We therefore performed subgroup analyses based on the control group mortality in each study.…”

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…Targeted searches of published literature were employed in addition to searches of databases 152,153 to identify utility values. Utility values were similar for short-and long-term infection patients when healed, but during infection the long-term patients experienced a much larger utility drop, as these infections were believed to be more severe in nature.…”