The preoperative history and physical exam have been performed (above) and the risk of major adverse cardiac events (MACE) is estimated below. That risk depends on 1) the risk of the proposed surgery and 2) the patient’s risk and functional capacity.
Risk Assessment:
1) Patient doesn’t have contraindications to elective surgery (that makes them a very high risk of MACE).
2) Surgery-Specific Cardiac Risk: Low risk (<1% ) or Intermediate risk (1-5%) or High risk (>5%)
3) Patient-Specific Cardiac Risk: (low-risk or higher-risk): RCRI (or ACS-SRC) risk factors include: ________. This corresponds to a _____ (low-risk or elevated) risk of major perioperative cardiovascular events (MI, pulmonary edema, ventricular fibrillation or primary cardiac arrest, and complete heart block)).
4) Functional Capacity (expressed in METS) = ______ METS. The patient reports being able to _____________(describe activities).
5) The 2014 ACC/AHA algorithm was followed and Labs and imaging studies have been considered as indicated by history and physical.
The procedure, alternative treatments, risks, and benefits were explained to the patient. The risk of MACE in the perioperative period was explained to the patient.
This patient is ______ risk for a ___________ risk procedure.
This evaluation will be transmitted to the surgery and anesthesia teams.
—END—
Key points and Important Links
- Duke Activity Status Index (DASI) on MDCal.com
- Metabolic Equivalents
- Cardiac Evaluation Algorithm(check this out)
- Risk for Myocardial Infarction or Cardiac Arrest (MICA) calculator.
- Preoperative-Risk Assessment Algorithm (2014 ACC/AHA Guidelines)
- Patients with active cardiovascular s/sx should get an ECG and be worked up just like it would be done without the surgery.
- Perioperative instructions to go with pre-op clearance e.g. starting a statin, beta-blockers, stopping anticoagulants, etc.
Other Useful Articles
Perioperative management of patients receiving anticoagulants
Preoperative Evaluation, AAFP
Preoperative Examination, FPNotebook.com
Preoperative Evaluation Form, AAFP
References
- 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Online Article Here.
- https://www.uptodate.com/contents/evaluation-of-cardiac-risk-prior-to-noncardiac-surgery
- Am Fam Physician. 2013 Mar 15;87(6):414-418.
- Am Fam Physician. 2000 Jul 15;62(2):387-396.
- AFP 2007;75:656, http://www.aafp.org/afp/2007/0301/p656.pdf
- Am Fam Physician. 2002 Nov 15;66(10):1889-1897. http://www.aafp.org/afp/2002/1115/p1889.html
- Pocket Primary Care
- http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/perioperative-evaluation/ (Last Accessed 4/24/2017)
- Read this article: http://www.aafp.org/afp/2013/0315/p414.html