title: Predicting outcomes: Is there utility in risk scores?
abstract: OBJECTIVE
  This review discusses the utility of risk scores, specifically, the role of preoperative risk scores in guiding the management of surgical patients, approaches to evaluate the quality of risk scores, and limitations to consider when applying risk scores in clinical practice.
  
  
  RESULTS
  This review shows how accurate predictions of perioperative risk can help inform patients and clinicians with respect to decision-making around surgery; identify patients who warrant further specialized investigations, new interventions intended to decrease risk, modifications in planned operative procedures, or intensification of postoperative monitoring; and facilitate fairer comparisons of outcomes between providers and hospitals. A preoperative risk score formally integrates several pieces of clinical information (e.g., age, comorbid disease, laboratory tests) to arrive at an overall estimate of an individual patient's expected risk for specific postoperative adverse events. A good risk score should be simple to incorporate in clinical practice, reliable when applied by different raters, and accurate at predicting postoperative risk. Several analytical methods (e.g., receiver operating characteristic curves, likelihood ratios, risk reclassification tables, observed vs predicted plots) are required to characterize the relevant domains that encompass the prognostic accuracy of a risk score. External validation is critical in determining whether the predictive accuracy of a risk score is preserved when applied to new settings, populations, or outcome events.
  
  
  CONCLUSIONS
  Preoperative risk scores help inform perioperative clinical decision-making. Future research must determine how estimates of preoperative risk can be updated with information from the intraoperative period, how risk information should be communicated to patients, and which interventions can improve outcomes among patients within newly identified risk strata.
authors.affiliation: Department of Anesthesia, Toronto General Hospital and University of Toronto, Toronto, ON, Canada. d.wijeysundera@utoronto.ca.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. d.wijeysundera@utoronto.ca.|Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. d.wijeysundera@utoronto.ca.|Department of Anesthesia and Pain Management, Toronto General Hospital, Eaton Wing 3-450, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. d.wijeysundera@utoronto.ca.
authors.forename: Duminda N
authors.identifier: http://orcid.org/0000-0002-5897-8605
authors.initials: DN
authors.lastname: Wijeysundera
mesh_terms: D003657:Decision Making; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*