Risk Stratification
Week 1: Discussion Board Scenarios
Posted on: Thursday, May 26, 2022 12:00:00 AM EDT
• A 60-year-old female with no previous cardiac history, except for preoperative for stratification for a new murmur, is sent to you. An echocardiogram is performed demonstrating an ejection fraction of 60%, and severe aortic stenosis. Her proposed surgery is a total knee replacement.
• A 25-year-old male is sent to you for preoperative risk stratification. His proposed surgery is an emergency cholecystectomy. He is active and has no exertional symptoms playing basketball for over an hour 3 times weekly. He has no previous cardiac, medical, or surgical history.
• A 75-year-old female with history of coronary artery disease with previous CABG and PCI, hypertension, and hyperlipidemia is sent to you for preoperative risk stratification. Her proposed surgery is hip replacement. You are unable to assess her functional status due to hip pain, which renders her mobility challenged. Her previous echocardiogram demonstrates an ejection fraction of 55–60% with no wall motion abnormality. She has no active anginal or exertional symptoms.
Risk Stratification
Risk stratification is essential in developing a systematic model of classifying patients and determining their level of risk. The first scenario is considered high-risk surgery. The reason is that any surgery in the peritoneum using vascular surgery is considered a risky operation. For instance, patients undergoing peritonectomy procedures have a high risk of post-operative infections and pneumonia (Engelman et al., 2019). Statistics indicate that only 25-30 percent of the patients successfully undergo the treatment processes and surgery.
The second scenario involves a 69-year-old patient who is a low or intermediate risk. The analysis shows that some of the information about the patient is false. The surgery should not be delayed. The second reason is that there is no indication of revascularization. The third reason is that oncology situations are considered sensitive. Delaying the surgery is equal to putting the patient at risk of additional health complications (Chen et al., 2021).
The third scenario provides the wrong information. Pre-operative mortality is mostly not cardiac. The consideration is the personal condition of a patient undergoing heart surgery. The scenario presents a low risk. The low risk shows that healthcare workers should not fear undertaking the surgery (Chen et al., 2021).
The consideration of the patients is critical in determining if they are at high, intermediate, or low risk. Assessment of a patient should examine if the patient has any unstable cardiac condition. For instance, if a patient has been on dialysis, it is critical to take precautions. Other factors include uncontrolled hypertension, which can be risky for patients undergoing surgery (Engelman et al., 2019). For instance, it is vital to consider the type of surgery and the urgency. It is vital to examine the functional capacity and the associated outcome in the risk model. Examination of patients in terms of the risk stratification in ensuring patient safety.
References
Chen, H., Mo, L., Hu, H., Ou, Y., & Luo, J. (2021). Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. Journal of cardiothoracic surgery, 16(1), 1-11.
Engelman, D. T., Ali, W. B., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., … & Boyle, E. M. (2019). Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA surgery, 154(8), 755-766.
