High-Risk Surgical Patients: Why We Should Pre-Optimize

In the United Kingdom, a recent analysis of an intensive care unit (ICU) database reported that surgical patients represented 45% of total ICU admissions with an important mortality rate since 20.1% of them died [1]. A surgical patient is considered at high risk if their preoperative status is altered or if the surgical procedure is prolonged and/or associated with heavy blood loss. Many attempts have been made to identify such patients early and to evaluate the impact of perioperative therapeutic optimization on outcome. In 1979, Shoemaker et al. [2] defined criteria for high surgical risk. These included: patient history: age more than 70 years with evidence of limited major physiologic function, previous severe cardiopulmonary or vascular illness, severe nutritional disorders critical factors: severe multiple trauma, massive acute blood loss, shock, septicemia or septic shock, respiratory failure, acute abdominal catastrophe, acute intestinal or renal failure surgical procedure factors: extensive surgery for cancer or prolonged surgery more than 8 hours.