Prostate Restored
Photo by Serinus Pexels Logo Photo: Serinus

Which surgeries are high risk?

Procedures with possible significant effect on hemodynamics, blood loss Colorectal surgery with bowel resection. Kidney transplant. Major joint replacement (shoulder, knee, and hip) Open radical prostatectomy, cystectomy. Major oncologic general surgery or gynecologic surgery. Major oncologic head and neck surgery.

uclahealth.org - Risk Stratification - Anesthesiology - UCLA Health
Do Down syndrome people have kids?
Do Down syndrome people have kids?

Yes. A woman with Down's syndrome can have children. If her partner does not have Down's syndrome, the theoretical chance of the child having...

Read More »
Last updated Jun 16, 2021
Can I take zinc every night?
Can I take zinc every night?

Zinc supplement, if taken at night will be beneficial for the body in multiple ways. Zinc is involved in the production of at least 300 enzymes,...

Read More »
Last updated Nov 15, 2019

Risk Stratification Before Elective Surgery

On this page:

Surgery Risk | Patient Medical Risk | Cardiac Risk | Pulmonary Risk | Renal Risk | Cognitive Dysfunction Risk | Risk of Difficult Pain Management Risk factors that increase the likelihood of perioperative morbidity and mortality may include the patient’s underlying health problems as well as factors associated with each specific type of surgery. By combining risk scores for patient co-morbidity and the complexity of surgery, we can stratify overall risk and determine which patients should undergo more extensive preoperative evaluation. If a patient who is scheduled for a non-emergency procedure is found to have medical conditions that are not under ideal control, this preoperative evaluation process can include optimization, or “prehabilitation”, so that the patient can be in the best possible health before surgery. This process may address blood pressure control, diabetes management, nutritional status, exercise tolerance, smoking cessation, and treatment of anemia, as examples. In the sections to follow, we outline a method of assigning a risk score to patient co-morbidity factors and surgical risk factors. We encourage referring physicians to send patients with risk scores of 7 or greater to our Preoperative Evaluation and Planning Center (PEPC) for an in-person visit and further evaluation. Patients with scores of 4 or less require no further screening, and will be interviewed by the physician anesthesiologist and the anesthesia team before surgery. Patients with intermediate risk scores may be referred for telephone screening by the PEPC staff.

back to top

Surgery Risk Stratification

The Surgical Risk Score assigns a numerical value to reflect the risk level associated with the procedure ranging from 1 (very low risk) to 5 (very high risk). These categories identify operations with increased potential for substantial blood loss or other intraoperative and postoperative risks. Surgical Risk Score Surgery Types 1- Very Low Risk Procedures that usually require only minimal or moderate sedation and have few physiologic effects Eye surgery

GI endoscopy (without stents)

Dental procedures 2- Low Risk Procedures associated with minimal physiologic effect Hernia repair

Are hairy men more intelligent?
Are hairy men more intelligent?

A survey of 117 male members of the high intelligence society Mensa found they were more likely than average to have hairy bodies. The most...

Read More »
Last updated Apr 9, 2021
How many times a night do guys get hard?
How many times a night do guys get hard?

Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But...

Read More »
Last updated Mar 13, 2018

ENT procedures without planned flap or neck dissection

Diagnostic cardiac catheterization

Interventional radiology

GI endoscopy with stent placement

Cystoscopy 3- Intermediate Risk Procedures associated with moderate changes in hemodynamics, risk of blood loss Intracranial and spine surgery

Gynecologic and urologic surgery

Intra-abdominal surgery without bowel resection

Intra-thoracic surgery without lung resection

Cardiac catheterization procedures including electrophysiology studies, ablations, AICD, pacemaker 4- High Risk Procedures with possible significant effect on hemodynamics, blood loss Colorectal surgery with bowel resection

Kidney transplant

Major joint replacement (shoulder, knee, and hip)

Open radical prostatectomy, cystectomy

Major oncologic general surgery or gynecologic surgery

Major oncologic head and neck surgery 5- Very High Risk Procedures with major impact on hemodynamics, fluid shifts, possible major blood loss Aortic surgery

Cardiac surgery

Intra-thoracic procedures with lung resection

Major transplant surgery (heart, lung, liver)

back to top

Patient Medical Risk Stratification

Pre-existing medical problems confer risk for perioperative complications, including cardiac decompensation, respiratory failure, acute kidney injury, and postoperative delirium or cognitive dysfunction. Patient Risk Score Patient Characteristics 1- Very Low Risk No known medical problems 2- Low Risk Hypertension

Hyperlipidemia

Asthma

Other chronic, stable medical condition without significant functional impairment 3- Intermediate Risk Age 70 or older

Non-insulin dependent diabetes

Morbid obesity (BMI > 30)

Anemia (hemoglobin < 10)

Mild renal insufficiency 4- High Risk Recent coronary stent

Chronic CHF

Insulin-dependent diabetes mellitus

Renal insufficiency: creatinine > 2

Moderate COPD: FEV1 50% to 70%

Obstructive sleep apnea

History of stroke or TIA

Known diagnosis of dementia

Chronic pain syndrome 5- Very High Risk Unstable or severe cardiac disease

Severe COPD: FEV1 < 50% predicted

Use of home oxygen

Pulmonary hypertension

Severe liver disease

Severe frailty; physical incapacitation

back to top

Cardiac Risk Factors

Very high risk – score of 5:

Unstable or severe angina

Recent MI

Decompensated CHF

Severe valvular disease

Moderate risk – patients with two or more of the following conditions receive a score of 4, and three or more conditions a score of 5:

History of ischemic heart disease

Which dry fruit increase testosterone?
Which dry fruit increase testosterone?

Macadamia nuts – these nuts are enriched with testosterone boosting monounsaturated fats and directly stimulates testosterone production. Tiger...

Read More »
Last updated Jul 4, 2018
What foods open up arteries?
What foods open up arteries?

Here are some of the best foods that unclog arteries to eat in order to prevent or clean clogged arteries. Berries. Strawberries, blueberries,...

Read More »
Last updated Jun 5, 2022

Chronic, stable CHF

History of stroke or TIA

Insulin-dependent diabetes mellitus

Renal disease with serum creatinine greater than 2 mg/dl

back to top

Pulmonary Risk Factors

Severe pulmonary disease – score of 5:

COPD with FEV1 less than 50 percent of predicted

Severe pulmonary hypertension

Need for home oxygen therapy

Moderate pulmonary disease – score of 4:

COPD with FEV1 between 50 and 70 percent of predicted

Moderate pulmonary hypertension

Obstructive sleep apnea

Greater than 20 pack-year smoking history

back to top

Renal Risk

The most significant risk factor for postoperative renal failure is preexisting renal disease. Patients with GFR less than or equal to 60 ml/min or serum creatinine greater than 1.5 mg/dl are assigned a risk score of 3.

back to top

Cognitive Dysfunction Risk

High risk – score of 4:

Current diagnosis of dementia or other cognitive disorder

Bed-bound state

Need for aid with activities of daily living

Significant impairment of vision or hearing

Moderate risk – score of 3:

Frailty

Age greater than 70

back to top

Risk of Difficult Pain Management

Postoperative pain control remains a key factor in length of stay, delay of intestinal motility after bowel resection, and patient satisfaction. Patients with chronic pain syndromes, high tolerance for opioids, or a history of substance abuse may be at high risk for difficult-to-manage postoperative pain. We recommend that patients with any of the following risk factors be assigned a risk score of 5 and referred to PEPC for preoperative evaluation and pain management:

Use of more than 6 doses per day of hydrocodone or hydromorphone

Use of a long-acting or extended-release opioid such as Oxycontin

Use of Suboxone

History of complex regional pain syndrome (regional sympathetic dystrophy)

History of substance abuse

Intrathecal pump or spinal cord stimulator

back to top

uclahealth.org - Risk Stratification - Anesthesiology - UCLA Health
Do you wash your hands after every diaper change?
Do you wash your hands after every diaper change?

Clearly, washing your hands after you change your baby's diaper is super important, but until your baby is secure, be sure to use some heavy-duty...

Read More »
Last updated Oct 20, 2018
Can turmeric cure prostate enlargement?
Can turmeric cure prostate enlargement?

Some studies suggest that low doses of turmeric (1/2 teaspoon serving per day) may have some efficacy in conditions such as benign prostatic...

Read More »
Last updated Aug 14, 2021
Why is water good for weight loss?
Why is water good for weight loss?

Water can be really helpful for weight loss. It is 100% calorie-free, helps you burn more calories and may even suppress your appetite if consumed...

Read More »
Last updated Mar 18, 2021
What is the best time of day to take Flomax?
What is the best time of day to take Flomax?

Ask your doctor if you have any questions. Take the capsule approximately 30 minutes after the same meal each day. Swallow the capsule whole. Do...

Read More »
Last updated Oct 18, 2019