Pre-op - History & Examination

Question 1

What are the 9 variables of survival?

Answer 1

Age, Sex, SES, aerobic fitness and history of: IHD; HF; CVA; PAD; RF

Question 2

What is the independent relative increased risk of dying due to the following diagnoses:

• MI, Heart Failure
• Diabetes
• Stroke
• Angina
• Renal Failure
• TIA
• Severe HTN

Answer 2

• 1.5
• 3 for T1, 2 for T2
• 1.5
• 1.2
• 1.5
• 1.2
• 1.5

Question 3

What is the relative risk of death following an MI and how does that impact surgical planning?

Answer 3

Up to 50-fold higher in the month following an MI. The risk likely exponentially falls between 1 and 12 months, by which time the risk has fallen to 1.5-3-fold.

Normally surgery should be delayed for 3-6 months following MI.

Question 4

What is the increased risk of death for an anticoagulated patient with drug eluting stents who stops their medication for surgery?

Answer 4

Up to 5-fold.

Question 5

In which types of surgeries does the risk of thromboses outweigh the risk of bleeding with aspirin

Answer 5

Brain, spinal canal, prostate.

Question 6

What is the increased risk of rhabdomyolysis due to surgery in patients taking statins?

Answer 6

There is no evidence of an increased risk.

Question 7

When stopping Warfarin for surgery in a patient with AF, what is the increased risk of thrombosis? What mitigating actions should you take?

Answer 7

For most patients the risk is negligible, and additional thromboprophylaxis is not necessary.

Where risk is increased because of valvular disease or previous cardiovascular events, high dose fractionated heparin can be given at home before admission