Correspondence  |   January 2020
Improving Pediatric Risk Stratification: Reply
Author Notes
  • Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts (V.G.N.).
  • (Accepted for publication October 3, 2019.)
    (Accepted for publication October 3, 2019.)×
Article Information
Correspondence   |   January 2020
Improving Pediatric Risk Stratification: Reply
Anesthesiology 1 2020, Vol.132, 213-214. doi:
Anesthesiology 1 2020, Vol.132, 213-214. doi:
Dr. Brown et al. have made important comments and raised good questions about the definition of intrinsic surgical risk and categorization of the different surgical procedures. We would like to take the opportunity to answer the questions and clarify intrinsic surgical risk stratification.
This study is an initial step toward risk stratification in patients under noncardiac surgeries, focusing on mortality.1  We would like to emphasize that the intrinsic surgical risk is the risk of 30-day mortality. It does not reflect the risk of morbidity including blood loss, possible postoperative mechanical ventilation, or unanticipated escalation of care and intensive care unit admission. For example, while patients undergoing craniosynostosis surgery may be considered at high risk for morbidity, the risk of mortality is low to nonexistent. In fact, a recent multicenter study by the pediatric craniofacial collaborative group reported a 15% complication rate.2  Despite this relatively high complication rate, there was no in-hospital mortality for patients undergoing cranial vault reconstruction surgery. This supports our categorization of craniosynostosis surgery as a procedure with a low intrinsic surgical risk of mortality.