Which patient is most at risk for perioperative mortality?

The patient most at risk for perioperative mortality is the one undergoing an emergency bowel resection with an ASA class IV designation. ASA classification categorizes patients based on their physical status prior to surgery, with class IV indicating severe systemic disease. This suggests significant underlying health issues that can increase the risk of complications during and after the surgical procedure.

Emergency surgeries are typically associated with higher risks compared to elective procedures due to less optimal preoperative preparation and the urgency of the situation, which may not allow for comprehensive evaluation and management of the patient’s comorbidities. In this case, the combination of being 70 years old, classified as ASA class IV, and undergoing an emergency procedure significantly heightens the risk of perioperative mortality.

The other scenarios involve patients who are either younger, in a better physical condition (such as ASA class I), or undergoing elective surgery, which generally carries a lower risk profile compared to emergent operations. Thus, these factors collectively contribute to a lower risk of perioperative mortality for those patients compared to the one described.