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High-risk non-cardiac surgical patients are patients who suffer more from complications after surgery than patients who are not identified as high-risk patients.

International guidelines advise multidisciplinary team discussions before surgery concerning high-risk patients to personalise management before and after surgery through shared decision making between the surgeon, anaesthesiologists and another consultant and other healthcare workers concerned with the patients' care. But who is a high-risk patient and how can anaesthesiologists and other physicians recognize these patients? Most high-risk patients are patients with one or more chronic diseases, often combined with frailty. The combination of the patient characteristics and the intended surgery defines their estimated risk during and after surgery. But who is really at high risk of those complications? Mortality risk calculation before surgery could help finding the high-risk patients but the calculators are not reliable enough yet because of lack of external validation on populations other than the population the model was developed on. Until the moment that intelligent risk calculators can identify high-risk patients reliably, the anaesthesiologist (most of the time) will have to identify high-risk non-cardiac surgical patients before surgery, mostly based on doubt regarding the risk-benefit ratio of the surgery. This thesis shows that many changes are made to the medical management of high-risk non-cardiac surgical patients who were discussed during a multidisciplinary meeting before surgery. During this research it was established that almost 50% of the Dutch hospitals executes team discussions before surgery voor high-risk non-cardiac surgical patients. A follow-study is ongoing in the Netherlands to determine the (cost)effectiveness of the execution of multidisciplinary team discussions before surgery for high-risk patients.