Medical Evaluation of the Surgical Patient

2018 ◽  
Author(s):  
Marie Gerhard-Herman ◽  
Jonathan Gates
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Stress Test ◽  
Risk Index ◽  
Fluid Management ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Surgical Patient ◽  
Improvement Program ◽  
Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This review contains 3 highly rendered figures, 12 tables, and 68 references.

Medical Evaluation of the Surgical Patient (SAGHE)

2014 ◽  
Author(s):  
Marie Gerhard-Herman ◽  
Jonathan Gates
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Stress Test ◽  
Risk Index ◽  
Fluid Management ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Surgical Patient ◽  
Improvement Program ◽  
Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This review contains 3 highly rendered figures, 12 tables, and 68 references.

Medical Evaluation of the Surgical Patient

2014 ◽  
Author(s):  
Marie Gerhard-Herman ◽  
Jonathan Gates
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Stress Test ◽  
Risk Index ◽  
Fluid Management ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Surgical Patient ◽  
Improvement Program ◽  
Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This chapter contains 3 highly rendered figures, 12 tables, 68 references, and 5 MCQs.

Medical Evaluation of the Surgical Patient

2014 ◽  
Author(s):  
Marie Gerhard-Herman ◽  
Jonathan Gates
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Stress Test ◽  
Risk Index ◽  
Fluid Management ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Surgical Patient ◽  
Improvement Program ◽  
Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This review contains 3 highly rendered figures, 12 tables, and 68 references.

Medical Evaluation of the Surgical Patient

2015 ◽  
Author(s):  
Marie Gerhard-Herman ◽  
Jonathan Gates
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Stress Test ◽  
Risk Index ◽  
Fluid Management ◽  
Postoperative Mortality ◽  
Noncardiac Surgery ◽  
Surgical Patient ◽  
Improvement Program ◽  
Medical Evaluation

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium. This chapter contains 3 highly rendered figures, 12 tables, 68 references, and 5 MCQs.

scholarly journals The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

2008 ◽  
Vol 36 (2) ◽  
pp. 167-173 ◽  
Author(s):  
P. J. Moran ◽  
T. Ghidella ◽  
G. Power ◽  
A. S. Jenkins ◽  
D. Whittle
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Positive Result ◽  
Cardiac Event ◽  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Frequent Use ◽  
Cardiac Outcome ◽  
The Impact

Lee and co-workers’ revised cardiac risk index was used to study the perioperative cardiac outcome of 296 patients. The index uses a history of ischaemic heart disease, congestive cardiac failure, diabetes treated with insulin, a creatinine greater than 180 μmol/l, cerebrovascular disease and high risk surgery as the risk factors involved in predicting a perioperative cardiac event. It was derived on the basis of data from patients over the age of 50 years undergoing elective, noncardiac surgery with an expected inpatient stay of two or more days. The presence of one, two and three or more risk factors predicted a risk of a major cardiac event of 1.3% (95% confidence interval [CI] 0.7 to 2.1), 3.6% (95% CI 2.1 to 5.6) and 9% (95% CI 5.5 to 13.8) respectively in Lee's derivation group of 2,893 patients. In our audit of 296 patients we observed a cardiac event rate of 0.8% (95% CI 0 to 2.3%), 6.7% (95% CI 1.6 to 10%) and 2% (95% CI 0 to 5.9%), in patients with one, two and three or more risk factors respectively. The more frequent use of ECGs and troponin levels in the routine postoperative care of high risk patients undergoing major noncardiac surgery is recommended on the basis of the frequency of a positive result and the impact of a positive result on a patient's management.

scholarly journals Postoperative Myocardial Injury in Patients Classified as Low Risk Preoperatively Is Associated With a Particularly Increased Risk of Long‐Term Mortality After Noncardiac Surgery

2021 ◽  
Author(s):  
Sunil K. Vasireddi ◽  
Erica Pivato ◽  
Enrique Soltero‐Mariscal ◽  
Raghuram Chava ◽  
Laurence O. James ◽  
...  
Keyword(s):  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Low Risk ◽  
Preoperative Risk ◽  
Improvement Program ◽  
Troponin Elevation ◽  
American College Of Surgeons ◽  
All Cause Mortality

Background Prior studies have shown an association between myocardial injury after noncardiac surgery (MINS) and all‐cause mortality in patients following noncardiac surgery. However, the association between preoperative risk assessments, Revised Cardiac Risk Index and American College of Surgeons National Surgical Quality Improvement Program, and postoperative troponin elevations and long‐term mortality is unknown. Methods and Results A retrospective chart review identified 548 patients who had a troponin I level drawn within 14 days of noncardiac surgery that required an overnight hospital stay. Patients aged 40 to 80 years with at least 2 cardiovascular risk factors were included, while those with trauma, pulmonary embolism, and neurosurgery were excluded. Kaplan–Meier survival and odds ratio (OR) with sensitivity/specificity analysis were performed to assess the association between preoperative risk and postoperative troponin elevation and all‐cause mortality at 1 year. Overall, 69%/31% were classified as low‐risk/high‐risk per the Revised Cardiac Risk Index and 66%/34% per American College of Surgeons National Surgical Quality Improvement Program. Comparing the low‐risk versus high‐risk groups, preoperative risk assessment was not associated with either postoperative troponin elevation or 1‐year mortality. MINS portended a 1‐year mortality of OR, 3.9 (95% CI, 2.44–6.33) in the total population. Patients classified as low risk preoperatively with MINS had the highest risk of 1‐year mortality (OR, 9.6; 95% CI, 4.27–24.38), with a low prevalence of statin use. Conclusions Current preoperative risk stratification tools do not prognosticate the risk of postoperative troponin elevation and all‐cause mortality at 1 year. Interestingly, patients classified as low risk preoperatively with MINS had a markedly higher 1‐year mortality risk compared with the general population, and most of them are not taking a statin. Our results suggest that evaluating preoperatively low‐risk patients for MINS presents an opportunity for prognostication, risk reclassification, and initiating therapies such as statins to mitigate long‐term risk.

scholarly journals Cumulative Duration of “Triple Low” State of Low Blood Pressure, Low Bispectral Index, and Low Minimum Alveolar Concentration of Volatile Anesthesia Is Not Associated with Increased Mortality

2014 ◽  
Vol 121 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Miklos D. Kertai ◽  
William D. White ◽  
Tong J. Gan
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Bispectral Index ◽  
Cox Regression ◽  
Minimum Alveolar Concentration ◽  
Risk Index ◽  
Noncardiac Surgery ◽  
Arterial Blood ◽  
Volatile Anesthesia ◽  
Cumulative Duration

Abstract Background: Mortality after noncardiac surgery has been associated with the “triple low state,” a combination of low mean arterial blood pressure (<75 mmHg), low bispectral index (<45), and low minimum alveolar concentration of volatile anesthesia (<0.70). The authors set out to determine whether duration of a triple low state and aggregate risk associated with individual diagnostic and procedure codes are independently associated with perioperative and intermediate-term mortality. Methods: The authors studied 16,263 patients (53 ± 16 yr) who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Multivariable logistic and Cox regression analyses were used to determine whether perioperative factors were independently associated with perioperative and intermediate-term all-cause mortality. Results: The 30-day mortality rate was 0.8%. There were statistically significant associations between 30-day mortality and various perioperative risk factors including age, American Society of Anesthesiologists Physical Status, emergency surgery, higher Cleveland Clinic Risk Index score, and year of surgery. Cumulative duration of triple low state was not associated with 30-day mortality (multivariable odds ratio, 0.99; 95% CI, 0.92 to 1.07). The clinical risk factors for 30-day mortality remained predictors of intermediate-term mortality, whereas cumulative duration of triple low was not associated with intermediate-term mortality (multivariable hazard ratio, 0.98; 95% CI, 0.97 to 1.01). The multivariable logistic regression (c-index = 0.932) and Cox regression (c-index = 0.860) models showed excellent discriminative abilities. Conclusion: The authors found no association between cumulative duration of triple low state and perioperative or intermediate-term mortality in noncardiac surgery patients.

scholarly journals A study on risk assessment of complex disasters in Busan coast

2021 ◽  
Vol 8 (4) ◽  
pp. 255-265
Author(s):  
Soonmi Hwang ◽  
Hyung-Min Oh ◽  
Soo-Yong Nam ◽  
Tae-Soon Kang
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Storm Surge ◽  
Disaster Preparedness ◽  
Risk Index ◽  
Maximum Flow ◽  
Assessment Index ◽  
Inundation Depth ◽  
Complex Disasters ◽  
Four Levels

In the vicinity of the coast, there is a risk of complex disasters in which inland flooding, wave overtopping, storm surge, and tsunami occur simultaneously. In order to prepare for such complex disasters, it is necessary to set priorities for disaster preparedness through risk assessment and establish countermeasures. In this study, risk assessment is carried out targeting on Marine city, Centum city, and Millak waterside parks in Busan, where complex disasters have occurred or are likely to occur. For risk assessment, inundation prediction map constructed by the Ministry of Public Administration and Security in consideration of sea level rise, rainfall and storm surge scenarios and authorized data on social and economic risk factors were collected. The socioeconomic risk factors selected are population, basements, buildings, sidewalks, and roads, and the risk criteria for damage targets are set for each risk factors. And it was assessed considering the maximum inundation depth and maximum flow velocity of the inundation prediction map. Weights for each factor were derived through expert questionnaires. The risk assessment index that was finally evaluated by calculating the risk index for each element and applying weights was expressed as a risk map by different colors into four levels of attention, caution, alert and danger.

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