Perioperative management of high-risk surgical patients poses many challenges. Patients may be deemed high risk based on poor baseline functional status, severe or uncontrolled co-morbidities, poor scores on risk and frailty calculators, invasiveness of the planned procedure and other qualitative and quantitative data. High-risk surgical patients may be more susceptible to complications and prolonged recovery. The scheduled surgery may be a suboptimal choice even in the setting of a “typical indication” compared to less invasive or even palliative options, which may not have been presented or considered. The risks of the surgery may outweigh the proposed benefits and may not align with the patient’s values and preferences.

How do we ensure that appropriate, high-quality decision making is being performed on our most vulnerable patients? A shift to a multidisciplinary approach to surgical decision making for high-risk patients scheduled...

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