Advances in Preoperative Risk Prediction: Enhancing Perioperative Outcomes

A multicenter preoperative nomogram now refines 30-day mortality estimates for patients undergoing transcatheter aortic valve replacement (TAVR), giving cardiac anesthesiologists, perioperative physicians, and surgical leaders a practical tool for individualized preoperative planning and resource allocation.

The model advances prior risk calculators by adding routine laboratory biomarkers to enhance discrimination beyond demographics- and procedure-only scores. By capturing metabolic, coagulation, and renal risk domains through common assays, the nomogram broadens risk characterization and enables earlier, targeted optimization and monitoring plans.

The study used a multicenter retrospective cohort of TAVR patients to derive a preoperative risk nomogram targeting 30-day mortality. In the derivation cohort the model achieved an AUC of 0.84 and retained discrimination with acceptable calibration on internal validation—indicating strong performance in development and internal testing.

Predictors combine the STS risk score with routine laboratory biomarkers—HbA1c, D-dimer, and uric acid—each independently associated with outcome after multivariable adjustment. Because these tests are routinely available or easily ordered preoperatively, the nomogram permits calculation of individualized, actionable risk estimates at the point of assessment; high-risk profiles can justify intensified renal-protective strategies and closer hemodynamic and renal monitoring.

Practical implementation calls for a phased workflow: embed the score in the preoperative checklist, ensure timely STS and lab results, and configure the EHR to compute the nomogram and deliver targeted alerts. Teams should map required data fields (STS, HbA1c, D-dimer, uric acid), set decision thresholds, and route automated notifications to perioperative teams with predefined escalation pathways. Anticipated barriers include the need for external validation across diverse populations, technical effort for EHR integration, potential alert fatigue, and governance around standardized pathways—so pilot deployment in a high-volume center with multidisciplinary oversight is advised before wider rollout.