Surg - High Risk Surgical

Question 1

Define

Answer 1

Many definitions and scoring systems.A high risk patient - has an expected mortality of >5%. Or twice the average risk of population having that procedure.High risk procedure - a procedure with a mortality of >5%

Question 2

Factors associated with peri-op risk

Answer 2

Patient, institutional, surgicalPt - Age> 65, Male (1.7x) Frail, porr nutrition, comorbid (CCF, cirrhosis)Institute - poor pre-op assessment, no ICU access, delated surgery, no seniorsSurgical - Emergency cavity surgery, complex (aoritc etc) intra-op events

Question 3

Scoring systems

Answer 3

ASA, Lee’s Revised Cardiac Risk Index, Possum, Dukes, CPETASA - widely used, inter-observer variability. No discriminatory power1 - 5 plus 6 for BSD1 - normal2 - mild systemic3 - majro systemic4 - systemic disease that is a constant threat to life5 - moribund and will not survive without opLee’s6 factors, 1point. Cardiac complication risk increases with poijnts

High Risk SurgeryIHDCCFCreatninine>176Inuslin for DMStroke

Dukes - quantifiy things in terms of METs 1=3.5ml/kg/min VO2<4 is bad

Question 4

Describe CPET

Answer 4

Test of dynamic cardiac function to give objective assessment of functional capacityAnaearobic threshold - the level of O2 consumption above which aerobic energy production is supplemented by anaerobic.<11ml/kg/min —> increased mortPeak oxygen consumption <15mls/kg/min (4 met)Ventilatroy efficiency (VE/VCO2)

Question 5

Other tests to requests

Answer 5

ECGEchoDobutamine stress testing —> inducible myocardial ischaemiaMyocardial perufsion scanning, exercise testsCPETBNP