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perioperative risk stratification (relative risk of non-cardiac surgeries)
Perioperative risk stratification for non-cardiac procedures
- High risk (> 5% complications)
a) emergent major operations (especially in the elderly)
b) aortic & other major vascular procedures
c) peripheral vascular procedures
d) prolonged surgical procedures
- large fluid shifts
- significant blood loss
- Intermediate risk (1-5% complications)
a) carotid endarterectomy
b) head & neck procedures
c) intraperitoneal & intrathoracic procedures
d) orthopedic surgery
e) prostate surgery
- Low risk (< 1% complications)
a) endoscopic procedures
b) superficial procedures
c) cataract surgery d breast surgery
- American College of Cardiology/American Heart Association guidelines recommend adding functional status (expressed in METs) plus a validated clinical risk score to guide risk stratification [2]
- serum NT-proBNP alternative to functional status [3]
Related
Caprini venous thromboembolism risk assessment score
perioperative risk assessment
General
risk assessment
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 17
American College of Physicians, Philadelphia 1998, 2006, 2015
- Wijeysundera DN, Pearse RM, Shulman MA et al
Assessment of functional capacity before major non-cardiac surgery:
an international, prospective cohort study.
Lancet. 2018 Jun 30;391(10140):2631-2640.
PMID: 30070222
- Lurati Buse G et al.
NT-proBNP or self-reported functional capacity in estimating risk of
cardiovascular events after noncardiac surgery.
JAMA Netw Open 2023 Nov 8; 6:e2342527.
PMID: 37938844 PMCID: PMC10632953 Free PMC article
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2811525