Epidemiology of adverse outcomes in high surgical risk patients in elective abdominal surgery: results of a prospective observational multicenter study

To describe the epidemiology of postoperative complications in high risk patients undergoing elective abdominal surgery and to compare their outcomes with the overall STOPRISK cohort. A prospective, multicenter observational cohort study was conducted in 38 Russian centers and included 11,478 adults undergoing elective surgery on abdominal and pelvic organs; among them, 1,367 patients (11.9 %) met guideline based criteria for high surgical risk. Postoperative complications within 30 days were recorded according to EPCO definitions and graded using the Clavien–Dindo classification, with detailed assessment of frequency, structure, severity and timing. CONCLUSIONS: High risk surgical patients, while representing a small proportion of the elective abdominal population, account for a disproportionally large share of severe complications and deaths. These findings support the implementation of targeted protocols for intensive monitoring, early diagnosis and prevention during the early postoperative window, as well as refinement of national perioperative risk stratification tools and resource planning.