How do you approach balancing the risks and benefits of elective surgery with patients who have multiple co-morbidities (e.g., frailty, chronic kidney disease, and COPD), when standard risk calculators do not capture the full complexity of their condition?

This is definitely a concern, and tools/calculators can only take us so far. I have come across scenarios where, the e.g., pulmonary respiratory failure calculator provided a low score, and based on the history, I thought the patient was at high risk. A few weeks later, before the surgery, the patient was admitted to the MICU and intubated with pneumonia. Thus, I placed a statement summarizing my concerns as some of the calculators generally address one aspect of patient's medical disease - "Thi...

Good question - Risk stratifying medically complex patients is a common and challenging scenario. The process should begin with a thorough review of the patient’s individual conditions, ensuring each is appropriately optimized to the extent possible. From there, factors to consider include the number and severity of medical conditions, the presence of frailty, functional status, nutrition assessment, cognitive impairment, and relevant social determinants of health (like support systems or access...