Introduction
Hearing that your STS risk score is “high” can feel like a door is closing. Many patients and families worry that surgery is unsafe - or even out of reach. The truth is more hopeful.
The STS (Society of Thoracic Surgeons) risk score is a prediction tool - not a verdict. It helps estimate risk, but it does not determine outcomes. Many patients with “high” scores still fare well, especially when treated at experienced centers using advanced techniques.
In this article, we’ll explain what “high” means numerically, interpret survival statistics in accessible terms, and outline all the real-world options for patients with elevated STS risk scores.
What Does the STS Score Measure?
The STS risk calculator analyzes data from a large database of cardiac surgery patients, estimating risk based on factors like:
- Age
- Kidney function
- Heart pumping efficiency (ejection fraction)
- Lung disease, diabetes, prior strokes
- Whether it’s a first-time or reoperative procedure
- Other serious health issues
It forecasts the chance of serious outcomes such as:
- Mortality (death during or shortly after surgery)
- Major complications, like stroke, kidney injury, or prolonged ventilator use
Importantly, the STS metric reflects averages across many patients. Individual results may vary - often depending on the surgical team and hospital involved.
What Counts as “High Risk”?
Patients are typically categorized as:
- Low risk: less than 2% chance of death
- Moderate risk: 2% to 8%
- High risk: above 8%
For instance, a 10% risk means 9 out of 10 similar patients survive the operation. A 20% risk means 4 out of 5 survive. Though sobering, these figures underscore that even in the “high risk” range, most patients still have successful outcomes.
Why “High Risk” Is the Beginning, Not the End
Hearing a high STS score can feel discouraging - but it shouldn’t stop the conversation. Other factors that influence outcome include:
- Surgeon and hospital experience with high-risk and complex cases
- Availability of minimally invasive and transcatheter procedures
- Patient’s overall health and ability to recover
- Emotional and social support during the recovery phase
Thus, an elevated STS score should prompt careful planning, not abandonment of any possibility.
Options for Patients with High STS Risk Scores
Second Opinions & Specialized Centers
Not all surgical programs are alike. High-volume centers and surgeons who routinely handle complex or reoperative cases often produce outcomes that exceed prediction models. A second opinion might reveal:
- Expertise in high-risk surgery
- Access to robotic or minimally invasive technologies
- A multidisciplinary team skilled in perioperative care
This approach can effectively reduce the real-world risk below what the raw score indicates.
Less Invasive Procedures
Alternative treatments may offer safer paths for high-risk patients:
- TAVR (Transcatheter Aortic Valve Replacement): Replaces the aortic valve through a blood vessel rather than open-chest surgery—especially helpful for older or frail patients.
- Minimally invasive CABG (Coronary Artery Bypass Grafting): Uses smaller incisions and may avoid heart-lung bypass.
- Hybrid surgical-catheter techniques: Combining procedures can deliver effective treatment with lower stress.
These options often result in shorter hospitalization, fewer complications, and faster recovery.
Medical & Lifestyle Management
For patients too fragile for surgery—even less invasive options—other strategies support health and
comfort:
- Medication optimization: Targeting blood pressure, cholesterol, fluid retention, symptoms like chest pain or shortness of breath
- Cardiac rehabilitation: Supervised exercise and heart education to build baseline strength
- Lifestyle interventions: Smoking cessation, nutrition support, blood sugar and blood pressure control
While these therapies don’t cure structural heart disease, they may enhance longevity and improve quality of life.
Hypothetical Patient Example
Consider a 75-year-old with severe aortic stenosis and an STS score estimating a 12% mortality risk for open-heart valve replacement.
Understandably, the thought of surgery is frightening. However, after seeking a second opinion at a high-volume center:
- Experts determine the patient qualifies for TAVR, reducing immediate risk significantly.
- Their historical data shows real outcomes that are better than the average suggested by the STS calculator.
- Pre-procedure optimization - including rehabilitation and tweaks to medications - further increases safety.
In the end, the patient successfully completes TAVR, leaves the hospital within a few days, and resumes normal activities within weeks.
Though hypothetical, this scenario reflects many real situations where a high STS score doesn’t close the door - it redirects the path.
The Emotional Impact of “High Risk”
Being told you’re “high risk” can weigh heavily emotionally - it may feel like a stigma, a death sentence, or defeat. Families need to know:
- You’re not alone. Many face this moment and still move forward successfully.
- Stories can be hopeful, not scary. A number does not tell the whole story - context and skillful care matter.
- Support is powerful. Professional guidance, counseling, or peer support can reduce anxiety and help families make informed decisions.
Conclusion
A high STS score is a signal—not a shutdown. It invites thoughtful action, not resignation.
High-risk patients can still thrive—especially when:
- They’ve consulted with expert centers or surgeons
- They’ve considered less risky procedural alternatives
- They’ve optimized medical and lifestyle health
- They’ve leaned on emotional and social support
If you’ve been told your risk is high, your best path forward is advocacy and exploration - not acceptance of the score as a final word.
