Body mass index (BMI) remains one of the most used variables in perioperative risk assessment, yet its ability to represent the biological complexity of obesity is increasingly questioned. Contemporary surgical patients frequently present not only excess body weight, but also varying degrees of insulin resistance, chronic inflammation, endothelial dysfunction, and impaired immune response. This perspective argues that surgical vulnerability is more accurately explained by metabolic dysfunction than by adiposity alone. We propose the concept of a metabolic risk phenotype, integrating anthropometric and biochemical variables such as BMI and glycated hemoglobin (HbA1c) into a unified framework for perioperative risk stratification. By moving beyond BMI as an isolated marker, this approach may improve the identification of high-risk patients, refine preoperative optimization, and support more personalized surgical decision-making.
Keywords: Obesity; Hemoglobin A, Glycosylated; Postoperative Complications; Surgical Outcomes; Metabolic Risk.
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