[dogmatism]

1) No, machine learning perfoms better than typical "risk scores" such as the RCRI (it was not tested against doctors clinical judgement)

2) Even so...so what? What we don't have is any reliable way to reduce surgical complications when the benefit outweighs the risk when the risk is elevated

[Agingcoder]

For 2) I guess that if you know you will die with high probability, you will search for ( if at all possible) an alternative treatment ( which might have side effects but at least you’re alive ) ?

[dogmatism]

It doesn't really work like that for the most part

If you actually need a really high risk surgery, you probably have a terrible prognosis without it

For instance, in the pivotal trial of transcatheter aortic valve replacement for aortic stenosis (TAVR) the people were deemed too high risk for surgery, so got nothing (well, medicine only which doesn't really change anything for this condition) or TAVR. The medicine arm had 50% mortality (1 year I think?) whereas the TAVR arm was "only" 30%!

Now that didn't mean all those 30% of deaths were due to the procedure or even the aortic stenosis. I think that ran 10% or so (going off memory here). They just had so many other problems. For comparison, TAVR is now done in low-risk people, and I think the 1 year mortality is <3%

The things that go into making someone "high risk" in the STS (cardiac surgery) risk score are for the most part pretty obvious. If your heart muscle is super weak (or you need a machine to keep going before surgery), you have kidney failure, prior strokes, combined heart problems, bad liver or lung disease, etc etc. You can calculate a score, but you probably can guess it from the door of the room