Pre-operative “clearance” is usually a cardiovascular risk evaluation and management. Surgical interventions have their risk. The goal is to make sure the surgeons and an adequate profile. A cardiologist evaluates the risk profile and optimizes the medical condition to the best possible health profile. This is done so that particular patients risk is as low as possible to tolerate the surgery well.
A Cardiologist follows basic principle :
- Clear outline of what is wrong, and how bad
- Risk evaluation by well developed scores such as revised Cardiac risk index (RCRI), Gupta preoperative risk score, (National Surgical Quality Improvement Program) NSQIP score.
- Determine if at optimal condition prior to procedure, and if not, develop plan to intervene
- Develop plan to prevent complications, including plan for chronic medications
- Proceed with risk management strategies in place
- Postpone for more testing
- Cancel offer alternative treatment
- In most cases pre-op eval won’t result in delay or cancellation.
- At every step, the goal is to compare risk and benefits of surgery. If the benefits of surgery outweigh the risk, your cardiologist will communicate with the referring about best optimal health.
- Estimate risk of death or MI with : – High risk surgery: > 5%
- Intermediate risk surgery : 1 to 5% – Low-risk surgery: < 1%
Type of surgery :
- High risk surgeries include aortic and peripheral vascular surgery
- Intermediate risk surgeries include intraperitoneal, intrathoracic, carotid endarterectomy, head and neck, orthopedic, and prostate surgeries
- Low risk surgeries include endoscopic and superficial procedures, cataract surgery, breast surgery, and ambulatory procedures