General Surgery Board Review Risk Assessment & Management 5

Question 1

Which of the following best describes the 'failure to rescue' metric as used in surgical quality improvement?

Accepted Answer

The rate of death following a major postoperative complication

Answer

Failure to rescue measures the rate of death after a major complication, reflecting the system's ability to detect and respond to complications rather than the complication rate itself.

Question 2

A 52-year-old woman with obstructive sleep apnea (OSA) is scheduled for elective laparoscopic Roux-en-Y gastric bypass. Which perioperative risk specifically attributable to OSA should be discussed?

Accepted Answer

Increased risk of postoperative respiratory failure and airway obstruction

Answer

OSA significantly increases risk of postoperative upper airway obstruction and respiratory failure, especially with opioid analgesia and residual anesthetic effects causing further pharyngeal muscle relaxation.

Question 3

The Caprini score is used to risk-stratify patients for perioperative VTE. Which patient scenario would score highest?

Accepted Answer

65-year-old man undergoing total colectomy with prior DVT and active cancer

Answer

Major abdominal surgery combined with age >60, prior DVT, and active malignancy yields a Caprini score ≥5, placing this patient in the highest-risk category for VTE.

Question 4

Which of the following laboratory values, if abnormal preoperatively, best predicts 30-day surgical mortality across multiple studies?

Accepted Answer

Serum albumin

Answer

Serum albumin is one of the strongest single-variable predictors of 30-day surgical mortality, reflecting overall nutritional status, hepatic synthetic function, and physiologic reserve.

Question 5

A 78-year-old man with dementia and multiple comorbidities requires right colectomy for T2N0 colon cancer. Which framework is most appropriate for a goals-of-care discussion about surgical risk?

Accepted Answer

Shared decision-making incorporating patient values, functional goals, and realistic outcome expectations

Answer

Shared decision-making incorporating the patient's values, functional goals, and realistic outcome expectations (including postoperative functional decline and nursing home risk) is the ethical standard for high-risk elderly patients.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Risk Assessment & Management 5