Cardiac Surgery Risk Stratification - Medical Algorithm

Description

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%

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Description

Specialty

Objective

ICD-10

University of Washington Cardiac Surgery Risk Stratification

Purpose: To evaluate the risk of cardiac surgery for a patient using the risk stratification model used at the University of Washington.

Description

Specialty

Objective

ICD-10