In the absence of emergency surgery and active cardiac disease, the surgery risk level should be assessed, and if low-risk (endoscopic, cataract, ambulatory, etc.), the patient should proceed to the OR.
If intermediate- or high-risk surgery is planned (in the setting of non-emergent surgery and no active cardiac conditions), the patient’s functional capacity in MET’s should be assessed. If the patient has good functional capacity (as defined by 4+ MET’s), then the patient should proceed to the OR.
If, however, the patient has poor functional capacity, then the patient’s total clinical risk factors should be tallied, including ischemic heart disease, renal insufficiency, CVA, diabetes, and history of CHF. If the patient has no risk factors, then they should proceed to the OR. If the patient has 1-2 of these risk factors, then the clinician should consider either proceeding to the OR with beta-blockade or ordering stress testing, if it would change the patient’s management.
If, though, the patient has 3-5 risk factors, then the physician should consider non-invasive coronary evaluation (stress testing) if it would change management.
The second of four resources in the app is the PeriOp Meds resource, for which a variety of anticoagulants and cardiac meds are reviewed regarding their (dis)continuation peri-operatively. Appropriately, ACC/AHA recommendation classes are included (which they were not for the first algorithm).
