WCA: Shared Decision-Making and Communicating Risk for High-Risk Surgical Patients

Our coverage of The World Congress of Anesthesiologists (WCA) in Marrakesh continues. Andy Cumpstey and Kate Leslie discuss high-risk surgical patients with anesthesiologists Debra Leung (The Peter MacCallum Cancer Centre, Melbourne) and Duminda Wijeysundera (St. Michael's Hospital, Toronto). They explore how "high risk" extends beyond mortality (noting ~2% elective major surgery mortality in middle/high-income countries) to complications, medical morbidity, cognitive and functional decline, return to independence, and psychosocial factors such as social support. They describe a structured shared decision-making clinic: triage and preparation before visits, explaining surgery as an explicit choice, eliciting patient values and goals, and matching them to clinical information; she notes training needs and barriers, especially surgical engagement, overcome via surgical champions and formalizing "corridor conversations."They outline practical risk communication (natural frequencies, meaningful language, focusing on major events, ranking vs average, and what's modifiable) and highlights evidence that patients may refuse interventions sooner for functional/cognitive decline than for mortality risk. The conversation emphasizes linking risk prediction to actionable care pathways, prehabilitation/posthabilitation, and frameworks for both modifiable and non-modifiable risk amid aging, increasingly complex surgical populations. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/