Risk Stratification and Multidisciplinary Follow-Up Are Transforming Perioperative Care

In the perioperative space, risk comes with the territory. But as the surgical landscape is constantly being reshaped by technological advancements, clinicians have more tools than ever at their disposal for predicting surgical risk and preventing complications. Information shared at Euroanaesthesia 2025 will include practice-changing tips for improved risk stratification and postoperative care.  

Risk assessment plays a key role in preoperative planning before major elective surgery. The preoperative evaluation can help clinicians weigh the benefits against the risks of the planned procedures and predict outcomes for surgical patients who are at high risk for complications. Based on this information, patients and physicians can decide together whether to proceed with surgery, delay the procedure, or consider alternative treatment options.  

“Risk assessment should not only focus on the risk of mortality and complications, but also patient-reported outcomes,” said Judith van Waes, MD, PhD, an anaesthesiologist and clinical researcher at the University Medical Center Utrecht in the Netherlands. “Decision-making should [centre] on outcomes that best meet the treatment goals of an individual patient.” During Sunday’s symposium covering risk management in noncardiac surgery, van Waes will brief the audience on risk calculators that may be used to predict the risk of complications and death, including the Revised Cardiac Risk Index and the ACS NSQIP calculator. Measures of functional capacity, disability, and frailty can also help assess whether a patient can tolerate the stress associated with surgery and recovery. “Troponin and NT-proBNP [levels measured] before surgery are both predictors of postoperative cardiovascular complications and death and, therefore, may be used to assess risks,” van Waes said. “However, I would not recommend using these routinely.” A study conducted at Bern University Hospital in Switzerland, presented Sunday in a poster session, will highlight the role of cardiovascular magnetic resonance imaging as a tool for perioperative cardiovascular risk stratification. 

“I think that careful multidisciplinary risk assessment and considering other treatment options in patients with high risk of complications and poor outcomes is most important to prevent unfavourable outcomes,” van Waes added. “When proceeding with the surgery as proposed and if time permits, patients should be optimised as much as possible according to current guidelines.” 

Even with adequate preoperative assessment of potential risks, some patients can deteriorate quickly after major surgery. Multidisciplinary follow-up after discharge from intensive care units (ICU) can benefit patients at risk for complications and potentially improve their long-term outcomes. Anne-Françoise Rousseau, MD, PhD, will challenge attendees to rethink postoperative care beyond the immediate perioperative period. Rousseau, who serves as the director of the post-ICU follow-up clinic at the University Hospital of Liège, in Belgium, stressed that clinicians should bear in mind the mid- and long-term consequences of postoperative complications, such as chronic pain, cognitive impairment, and psychological distress. Strategies for the detection, management, and prevention of such complications should focus on patient-centred recovery and continuing care beyond discharge from the ICU.  

“In our post-ICU clinic, we conduct systematic post-ICU consultations during the year following ICU discharge, from the hospital in the general ward to 12 months after discharge,” Rousseau explained. “We assess for physical, cognitive, and psychological sequelae using validated questionnaires, tests, or biomarkers. Interventions include personalised education and referrals to different supporting services when needed. We also focus on empowering patients through structured communication and coordination with primary care physicians. Early detection and targeted interventions are key to improving long-term recovery and preventing avoidable suffering.” 

Interdisciplinary collaboration is crucial for ensuring continuity of care for critically ill patients, with anaesthesiologists playing a key role in care coordination. This collaborative approach has the potential to increase the quality of care, reduce readmissions, and improve patient outcomes. “Multidisciplinary models ensure that complex patient needs are addressed holistically,” Rousseau added. “Critical illness affects not just organs, but also minds, families, and life trajectories. By integrating input from physicians, nurses, dieticians, physiotherapists, psychologists, and social workers — both during and after ICU stay — we can better detect complications, coordinate follow-up, and tailor rehabilitation. These models improve outcomes, reduce fragmentation of care, and increase patient and staff satisfaction. In my experience, they also help bridge the gap between acute care and long-term wellbeing.”