Cochran and Verrier reported a risk stratification worksheet used at the University of Washington. This can help identify patients who may be at greater risk for cardiac surgery. The authors are from the Universities of Wisconsin and Washington (Seattle).
|
Type of Surgery |
Isolated Procedure |
Complex Procedure |
|---|---|---|
|
coronary artery bypass graft (CABG) |
CABG alone |
CABG and valve |
|
valvular |
single valve |
multiple valve |
|
thoracic procedure |
simple |
complex |
|
redo procedure |
NA |
valve or CABG |
|
ventricle |
NA |
ventricular aneurysm |
|
other |
simple |
complex |
Parameters:
(1) age
(2) gender
(3) angina at rest
(4) history of acute myocardial infarction (AMI)
(5) history of congestive heart failure (CHF)
(6) timeliness of the cardiac surgery
(7) left ventricular end diastolic pressure in mm Hg (LVEDP)
(8) mean pulmonary artery pressure in mm Hg
(9) intra-aortic balloon pump (IABP)
(10) serum creatinine
(11) prothrombin time
(12) history of diabetes mellitus
(13) history of carotid artery disease
|
Parameter |
Finding |
Major Risk Points |
Minor Risk Points |
|---|---|---|---|
|
age |
> 75 years of age |
1 |
0 |
|
|
70 - 75 years |
0 |
1 |
|
|
< 70 years |
0 |
0 |
|
gender |
female |
0 |
1 |
|
|
male |
0 |
0 |
|
angina at rest |
absent |
0 |
0 |
|
|
present |
1 |
0 |
|
history of AMI |
none |
0 |
0 |
|
|
> 14 days ago |
0 |
0 |
|
|
<= 14 days ago |
1 |
0 |
|
history of CHF |
absent |
0 |
0 |
|
|
present |
1 |
0 |
|
timeliness of surgery |
emergency |
1 |
0 |
|
|
urgent |
0 |
1 |
|
|
elective |
0 |
0 |
|
LVEDP in mm Hg |
> 20 mm Hg |
1 |
0 |
|
|
<= 20 mm Hg |
0 |
0 |
|
mean pulmonary artery |
> 25 mm Hg |
1 |
0 |
|
|
<= 25 mm Hg |
0 |
0 |
|
intra-aortic balloon pump |
not used |
0 |
0 |
|
|
used preoperatively |
1 |
0 |
|
serum creatinine |
>= 3.0 mg/dL |
1 |
0 |
|
|
2.0 to 2.9 mg/dL |
0 |
1 |
|
prothrombin time |
> 15 seconds |
0 |
1 |
|
|
<= 15 seconds |
0 |
0 |
|
history of diabetes |
absent |
0 |
0 |
|
|
present |
1 |
0 |
|
history of carotid artery disease |
absent |
0 |
0 |
|
|
present |
1 |
0 |
|
Type of Surgery |
Risk Factors |
Risk Group |
|---|---|---|
|
isolated procedure |
0 major and 0 minor |
low risk (A) |
|
isolated procedure |
1 major and 0-1 minor |
low to moderate risk (B) |
|
isolated procedure |
2 major and 0-1 minor |
moderate risk (C) |
|
complex procedure |
0 major and 0 minor |
moderate risk (C) |
|
isolated procedure |
2 major and >= 2 minor |
moderate to high risk (D) |
|
isolated procedure |
3 major and 0-1 minor |
moderate to high risk (D) |
|
complex procedure |
1 major and 0-1 minor |
moderate to high risk (D) |
|
isolated procedure |
3 major and >=2 minor |
high risk (E) |
|
isolated procedure |
4 major and >= 0 minor |
high risk (E) |
|
complex procedure |
2 major and >= 0 minor |
high risk (E) |
where:
• The mortality risk for group A was <= 3%.
• The mortality risk for group E was > 20%
Purpose: To evaluate the risk of cardiac surgery for a patient using the risk stratification model used at the University of Washington.
Specialty: Cardiology, Surgery, general
Objective: risk factors, severity, prognosis, stage, complications, selection
ICD-10: I97.1,
