S.A.F.E. Score 2.0 — evolution of integral surgical risk stratification scale in aesthetic plastic surgery

Objective. To present an improved model for preoperative surgical risk stratification in aesthetic plastic surgery — S.A.F.E. Score 2.0. Material and methods. Considering modern literature data, clinical experience and previous system for objective assessment of risk factors in body contouring, we developed a multifactorial surgical risk assessment model incorporating 10 parameters of the patient and surgical intervention. Each factor has three-level risk gradation with appropriate scores (1/2/4). Results. An improved integrated scale for surgical risk stratification in aesthetic plastic surgery — S.A.F.E. Score 2.0 — was developed. The last one is based on previous system for objective assessment of risk factors in body contouring. Prognostic approach to temperature assessment is developed where inadvertent perioperative hypothermia is considered not as a fixed intraoperative condition, but rather as a predictor of surgical risk during preoperative planning. The scale integrates validated international risk stratification tools, including the Caprini scale for assessing the risk of venous thromboembolic complications. This enhanced validity and reproducibility of the model. Quantitative standardization of individual risk factors, including smoker’s index (pack-years), reduced subjectivity of clinical assessment and improved accuracy of surgical risk stratification. The updated S.A.F.E. Score 2.0 includes the following risk factors: surgery time, risk of inadvertent perioperative hypothermia, smoking status, combination of procedures, body mass index, surgical area, lipoaspirate volume, red blood cell counts, ASA grade and risk of thromboembolic complications (Caprini scale). The total score allows the patient to be classified into one of three surgical risk categories. The proposed model can be considered as a basic element of emerging surgical risk management system in aesthetic plastic surgery (S.A.F.E. System), integrating patient parameters, surgical characteristics and prognostic models for perioperative complications. Conclusion. The integrated S.A.F.E. Score 2.0 scale is a simple and reproducible preoperative risk stratification tool enabling standardized safety assessment in aesthetic surgical procedures.