Assessment of Pre-operative Risk in Complex Cardiac Surgery

In cardiac surgery several risk-assessment scoring models have been developed for over three decades achieving these detailed aims: (a) to provide information about surgical risk to patients, their families, and surgeons; (b) to predict patient’s length of stay and, consequently, hospital stay, and insurance costs; (c) to modify surgical risk factors and ameliorate patient’s outcome; and (d) to use risk adjustment for checking providers’ performances and allocate economic resources. Performances of risk models are briefly discussed to introduce the main scoring models developed for cardiac surgery that are eventually analyzed. Particular attention is given to the high-risk patients, evaluating and highlighting those variables that may be modified, obtaining a decrease in postoperative mortality and morbidity. However, applying a risk score, we should consider that mathematical rules applied to the human body will not always get exact results, and risk-adjusted outcomes may differ between healthcare providers. In this view, risk scores should be considered in conjunction with other standards of good clinical practice with the aim to improve patients’ survival, mental and physical health after cardiac surgery, even in high-risk categories.