Preoperative Cardiovascular Risk Assessment & Surgical Clearance

Stating that a patient is "cleared for surgery" is no longer considered adequate; rather, the patient should be assessed for surgical risk, a major component of which is cardiovascular risk. The risk level helps the surgical team determine which preoperative, intraoperative, and postoperative assessments and therapies are indicated.

The American College of Cardiology/American Heart Association approach to risk stratification of patients prior to non cardiac surgery includes assessing the urgency of surgery, the presence of active cardiac conditions, the risk of surgery, the patients functional capacity, and the presence of other clinical risk predictors as defined by the Revised cardiac Risk Index (RCRI).  The RCRI is based on six factos that predict major cardiac complications: high risk surgery; history of ischemic heart disease, heart failure, or cerebrovascular disease; diabetes mellitus treated with insulin; and renal insufficiency (serum creatinine .2 mg/dL)  Cardiac complications occur in approximately 1% of patients with zero or one risk factor, 5% of those with two or more risk factors, and 10% of those with three or more risk factors.
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