Peri-op  TOC  

PERIOPERATIVE POCKET MANUAL 2005  (Contents)  - 3rd Edition
Maracus Magallanes, MD 2005

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 cardiac death and nonfatal MI)

INTERMEDIATE (<5%)

LOW (<1%)

*This stratification provides estimates of cardiac risk based on the surgical procedure alone, not taking into account any patient-specific factors. Additionally, it is very important to understand that not all surgical risk is cardiac risk.

ESTIMATES OF SURGICAL STRESS FOR COMMON SURGICAL PROCEDURES:

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)

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 inpatient cases fall in between these two extremes, technically within the urgent surgery category, and the timeframe to get to the OR can vary from hours to days depending on the underlying condition.

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 surgical 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.

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)