• Jonathan P Bedford, Oliver C Redfern, Benjamin O'Brien, and Peter J Watkinson.
• Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford.
• Curr Opin Anaesthesiol. 2024 Nov 4.

Purpose Of ReviewPerioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated. In this review, we introduce key model performance metrics, highlight pitfalls in model development, and examine current perioperative risk scores, their limitations, and future directions in risk modelling.Recent FindingsNewer perioperative risk scores developed in larger cohorts appear to outperform older tools. Recent updates have further improved their performance. Machine learning techniques show promise in leveraging multidimensional data, but integrating these complex tools into clinical practice requires further validation, and a focus on implementation principles to ensure these tools are trusted and usable.SummaryAll perioperative risk scores have some limitations, highlighting the need for robust model development and validation. Advancements in machine learning present promising opportunities to enhance this field, particularly through the integration of diverse data sources that may improve predictive performance. Future work should focus on improving model interpretability and incorporating continuous learning mechanisms to increase their clinical utility.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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