pre-operative assessment

see also:

• general surgery

• for emergency surgery, pre-op assessment uncommonly alters course or outcome of surgery as the urgency takes precedence
• pre-op cardiac risk assessment is required for elective surgery dependent upon ¹⁾:
  • surgical risk factors:
    • low risk surgery (<1%)
      • endoscopy, minor procedures, dental, cataract, breast, gynae, minor orthopaedic or urologic surgery
    • intermediate risk (1-5%)
      • abdominal or thoracic surgery, carotid endarterectomy, hean and neck surgery, major ortho surgery, prostate surgery, endovascular aneurysm repair
    • high risk (>5%)
      • aortic and major vascular surgery, peripheral vascular surgery
  • patient co-morbidity factors
    • patients aged > 70yrs or those with co-morbid factors should have a full pre-op assessment
    • CXR is rarely needed pre-op unless there is unexplained cough/SOB or patient is at increased risk of post-op pulmonary complications
    • ECG is recommended for:
      • those with cardiac risk factors including PH hyypertension, renal impairment, diabetes
      • intermediate or high risk surgery
    • FBE and U&E is recommended for:
      • intermediate or high risk surgery
      • NB. eGFR < 60mL/min is associated with increased incidence of cardiovascular complications
    • patients at risk of cardiovascular disease or with known cardiac conditions should be considered for further cardiac assessment which may include stress testing (and also echo if undiagnosed SOB, worsening SOB, or suspected significant valvular disease).
    • patients with chronic lung disease may require lung function tests

• acute STEMI
• unstable coronary syndromes
• decompensated cardiac failure (class IV)
• significant arrhythmias:
  • 2nd or 3rd degree heart block
  • AF/flutter with ventricular rate > 100/min
  • sustained SVT
  • sustained or new VT
  • sinus bradycardia < 40/minute esp. with Hx of syncope or pre-syncope
• valvular heart disease (esp. severe aortic stenosis or mitral stenosis)

• terminal CCF
• severe pulmonary hypertension
• uncontrolled VT
• severe left main coronary artery stenosis not suitable for revascularisation
• cardiogenic shock