ASSESSMENT OF PERIOPERATIVE AND POSTOPERA TIVE RISK

The aim of preoperative risk analysis is to reduce postoperative morbi dity and mortality by identification of compromised organ function whi ch can be improved by targeted preoperative measures and problem-orien ted postoperative therapy. Ideally, therefore, preoperative risk asses sment, influences the timing of the surgical procedure, the choice of the surgical approach, and the postoperative management. Identificatio n of preexisting relevant disorders that may influence the postoperati ve course is an essential prerequisite of risk analysis. While preoper ative risk analysis today gains in importance with the increasing exte nt of elective surgical procedures, preoperative risk evaluation still plays a minor role in the emergency situation when the given patient- dependent risk usually has to be accepted. Objective risk evaluation d epends on the general and nutritional status, the pulmonary, cardio-va scular, hepatic, and renal function, and the cooperation of the patien t. These factors, however, clearly have to be seen in relation to the type and extent of the planned surgical procedure. The selection of ad ditional tests of organ function, exceeding the standard tests require d prior to any surgical intervention, must be guided by the extent of the planned surgical procedure, the physiologic alterations associated with the surgical procedure, and the suspected underlying organ dysfu nction. Generally accepted multifactorial classification systems to id entify patients at risk for a wide spectrum of surgical procedures are currently not available. Using the model of esophagectomy in patients with esophageal cancer we could, however, demonstrate that a quantita tive assessment of the peri-and postoperative risk based on preoperati vely available physiologic parameters is possible and markedly reduces postoperative mortality when applied prospectively. The development a nd validation of similar risk-score systems for other surgical procedu res should be considered.