EuroSCORE II can be used to predict operative risk for which one of the following procedures?
The updated euroSCORE II (2011) includes weighting for type of intervention, and can be used for isolated CABG, valve replacement, structural repair, maze, and tumour resection.
What does euroSCORE II estimate?
The updated euroSCORE II (2011) was derived from a large dataset where the primary outcome was mortality at the base hospital. It does not predict morbidity. EuroSCORE II provides weighting for the type of intervention, not just CABG.
The following conditions are considered to be clinical risk factors and independent clinical determinants of major peri-operative cardiac events, except:
Diabetes requiring insulin therapy is a risk factor/major determinant of peri-operative cardiac events. The LEE index is considered to be one of the best currently available risk prediction indexes for non-cardiac surgery. The 5 independent clinical determinants of major peri-operative cardiac events are as listed in the question options. High risk type of surgery is the sixth factor that is included in the index. All factors contribute equally and the incidence of major cardiac complications is estimated at 0.4, 0.9, 7, and 11% in patients with an index of 0, 1, 2, and ≥3 points, respectively. The ESC guidelines recommend that the LEE index model applying these six different variables for perioperative cardiac risk be used. The guidelines also use these 5 clinical risk factors to guide recommendations to initiate statin and beta-blocker therapy and to consider non-invasive testing.
A patient has been referred for CABG. He is concerned about complications and wants to know the risk of perioperative stroke.
What is the typical nationally reported risk?
Although the absolute risks will vary from unit to unit and from patient to patient, it is useful to know the typical risks of cardiac surgery. The Sixth National Adult Cardiac Surgical Database Report gives a typical risk of 1% for isolated CABG. An aortic valve replacement increases this risk to closer to 2%. Off-pump CABG avoids cardiopulmonary bypass and there is some evidence demonstrating a reduced risk of stroke, although since the patients selected for off-pump CABG differ in their risks, it is difficult to apply this to the whole population. Poldermans et al. ESC guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. EHJ 2009; 30: 2769–2812.
Boersma E, Kertai MD, Schouten O, et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118: 1134–41.
Biccard BM. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity. Anaesthesia 2005; 60: 588–93.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–9. Vahanian et al. ESC guidelines for the management of valvular heart disease (version 2012). EHJ 2012; 33: 2451–96.
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007; 116: 1971–96.
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