Surgical Risk for Cardiac Event

Aka: Surgical Risk for Cardiac Event, High Risk Surgery, Intermediate Risk Surgery, Low Risk Surgery, Category I Surgery

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II. Indications

  1. Preoperative Cardiovascular Evaluation

III. Type: High Risk Surgery (Cardiac event risk >5%)

  1. Emergency surgery (especially over age 75 years)
  2. Major Thoracic Procedures
  3. Cardiac procedures
  4. Aortic or other major vascular procedures
  5. Peripheral arterial vascular procedures
  6. Prolonged surgery anticipated (>4 hours)
    1. Anticipated large fluid shift or blood loss
    2. Examples: Whipple Procedure, Major spinal surgery

IV. Type: Intermediate Risk Surgery (Cardiac event risk 1-5%)

  1. Orthopedic surgery
  2. Urologic surgery
  3. Uncomplicated abdominal or thoracic surgery
  4. Uncomplicated head and neck surgery
  5. Carotid endarterectomy
  6. Prostate Surgery

V. Type: Low Risk Surgery (Category I, Cardiac event risk <1%)

  1. Endoscopy
  2. Bronchoscopy
  3. Hysteroscopy
  4. Cystoscopy
  5. Dermatologic procedures (skin and subcutaneous tissue)
  6. Breast biopsy or other Breast surgery
  7. Ophthalmologic Procedures (e.g. Cataract resection)
  8. Ambulatory surgery (contrast with hospital procedures)
    1. Ambulatory surgery mortality: 1 in 22,545
    2. Warner (1993) JAMA 270:1437-1441 [PubMed]

VI. Precautions

  1. Perioperative cardiac event risk is not independently correlated with Anesthesia (e.g. general) type or surgery duration

VII. Resources

  1. STS Risk Calculator for vascular surgery perioperative risk
    1. http://www.sts.org/sections/stsnationaldatabase/riskcalculator/

VIII. References

  1. Eagle (2002) Circulation 105:1257-67 [PubMed]
  2. Karnath (2002) Am Fam Physician 66(10):1889-97 [PubMed]

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