Development of a List of High-Risk Operations for Patients 65 Years and Older

Abstract

High-risk surgery is not well defined, but surgeons know it when they see it. Surgery can be high risk owing to patient-specific factors or operation-specific factors.^1,2 However, teasing out these commingled contributors can be challenging. There is little debate that open repair of an abdominal aortic aneurysm is high-risk surgery. However, this operation is almost exclusively performed on older patients, most of whom have preexisting cardiovascular disease or risk factors for vascular disease. As such, the operation is high risk partly owing to the characteristics of the patients on whom it is routinely performed. Nonetheless, the operation itself has inherent risks given the need for laparotomy and the cardiac stress engendered by aortic cross-clamping.