Surgical Risk Assessment

- Age:
    - references:
           - Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life
           - Outcome of hip and knee arthroplasty in persons aged 80 years and older
           - Revision total hip arthroplasty in octogenarians. A case-control study
           - Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year follow-up

- Metabolic Syndrome:
           - coexistence of diabetes, hypertension, obesity, and dyslipidemia 
           - having 3/4 indicates metabolic syndrome
           - references:
                   - Quantifying Cardiovascular Risks in Patients With Metabolic Syndrome Undergoing Total Joint Arthroplasty

- Specific Labs to Consider:
     - troponin:
           - Troponin T as a predictive marker of morbidity in patients with fractured neck of femur
     - albumin:
           - Preoperative albumin and surgical site identify surgical risk for major postoperative complications
           - Pre and Postoperative Serum Albumin Levels as Predictors of Surgical Outcome
           - Impact of Comorbidities on Hospitalization Costs Following Hip Fracture
     - creatinine:
           - chronic renal failure may be the biggest independent risk factor for mortality;  
           - references:
                    - Value of routine blood tests for prediction of mortality risk in hip fracture patients
                    - Rate of and risk factors for acute inpatient mortality after orthopaedic surgery


- Comp. of Multifactorial Index Score to Estimate Cardiac Risk in N.C.S. (Cardiac risks and complications of noncardiac surgery)
        - S3 gallop or jugular venous distension or preoperative P.E.Transmural or subendocardial M.I. in prev. 6 months PVC > 5/min. at any time;
        - rhythm other than NSR or P.A.C. on last preop EKG              
        - age over 70 years                                               
        - aortic stenosis                 
        - hypokalemia: <  3.0
        - HCO3 < 20.0
        - BUN > 50.0
        - Cr > 3.0
        - PO2 < 60.0
        - PCO2 > 50.0
        - Incr AST.
        - pt bed ridden from non cardiac causes

- Considerations for Hip Fractures:
           - The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures  
           - Troponin T as a predictive marker of morbidity in patients with fractured neck of femur.
           - Preoperative cardiac evaluation of patients with acute hip fracture.
           - Use of Medical Comorbidities to Predict Complications After Hip Fracture Surgery in the Elderly



Multifactorial index of cardiac risk in noncardiac surgical procedures

Stair climbing as an indicator of pulmonary function

A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient

Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial

Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients

Same-day versus staged anterior-posterior spinal surgery in a neuromuscular scoliosis population: the evaluation of medical complications

- References:
           - Timothy J. Hinlicky, &c., Appellant, v. David C. Dreyfuss, et al., Respondents.
           - How Much of a Cardiac Work-up Is Too Much?
           - $4 Million Dollar Settlement - Hypoxic Brain Injury in an Adult; Improper Surgical Clearance
           - Preoperative Testing and Clearance
 
           - Estate of Bonnie J. Rauch, Deceased, Superior Court of PA v. H Mike-Mayer, M.D., M Clark, M.D., Michael Feffer, M.D. 
           - Medical Malpractice. A Case of Inadequate Informed Consent

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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, March 26, 2013 4:11 pm