Why is the surgical high-risk patient still at risk?

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Abstract
Over the last decades, we have seen a continuous improvement of perioperative anaesthetic and surgical care leading to a general reduction of morbidity and mortality, despite the surgical population getting older and with more co-morbidity. Nevertheless, and despite these improvements, there is a general agreement that the preoperative high-risk patient still carries a high risk of postoperative morbidity and mortality. How are we going to change this?