Peri-op  

THE BELLFLOWER PERIOPERATIVE POCKET MANUAL
Maracus Magallanes, MD 2001

Chapter 3  -  SURGICAL CONSIDERATIONS

STRESS OF SURGERY

CARDIAC RISK STRATIFICATION FOR NONCARDIAC SURGERY:
(American College of Cardiology/American Heart Association, 1996)

HIGH (>5% incidence of combined cardiac death and nonfatal MI)

INTERMEDIATE (<5%)

LOW (<1%)

ESTIMATES OF SURGICAL STRESS FOR COMMON SURGICAL PROCEDURES:

URGENCY OF SURGERY

*This is the key controlling factor in determining what can be done for medical problems preoperatively. The two extremes are easy: emergency surgery is immediate and no delay is possible, despite underlying medical conditions; elective surgery is always elective and whatever needs to be done preoperatively to optimize the patient should be done. The majority of cases fall in between these two extremes, even among inpatients.

If there is ever any question as to the necessary timeframe for performing surgery, ASK THE SURGEON! If the case is not emergent and you need to optimize the patient preoperatively, specifically ask the surgeon how much time you can allot to do this without adversely impacting the patient's overall prognosis. On the flip side, the surgeon will want to know how long you think it will take to medically optimize a non-emergent case for surgery.

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