Labs, Imaging, and Studies During Preoperative Risk Assessment

HealthCare

  1. Get a pregnancy test for every woman who can be pregnant.
  2. Use the estimated risk of a major adverse cardiac event (from RCRI, ACS-SRC, or another calculator) to categorize patients into low-risk or higher-risk. Further work-up is determined by the patient’s risk (which is calculated based on information from the patient’s history and physical exam).
  3. Low-risk patients are those whose estimated risk of MACE(major adverse cardiac event) is less than 1 percent. On the RCRI, these are patients with 0 or 1 risk factor.  “For patients with a low risk of perioperative MACE, further testing is not recommended before the planned operation. (Level of Evidence: B)” 2014 ACC/AHA Guidelines. This group will include all of your healthy patients.
  4.  Higher-risk (or elevated risk) patients are those whose risk of MACE is 1 percent or higher. Elevated risk patients may require additional cardiovascular evaluation. Such work-up will depend on the risk factors that raised their risk and may include ECG, stress testing, echocardiography, or cardiologist consultation. Perform these tests if they are indicated for the patient even if they were not having surgery.
  5. In considering a further cardiovascular evaluation for higher-risk patients, use the algorithm from the 2014 ACC/AHA Guidelines. “In this approach, the patient’s functional capacity plays an important role. In patients who can perform ≥4 METs of activity, we do not order additional tests. For those whose functional capacity is lower or unknown, additional testing may be indicated if it will influence perioperative care.” Uptodate.com
  6. Don’t get ECGs in low-risk patients (2014 ACC/AHA Guidelines)
  7. Don’t get ECGs in patients going for low-risk procedures (2014 ACC/AHA Guidelines)
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