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Estimating the risk of mortality and morbidity for patients being considered for CABG surgery
General Cardiology Guideline Snapshot
Preoperative Estimation of Risk of Mortality, Cerebrovascular Accident, and Mediastinitis For use only in isolated CABG surgery Directions: Locate outcome of interest, eg, mortality. Use the score in that column for each relevant preoperative variable, then sum these scores to get the total score. Take the total score and look up the approximate preoperative risk in the table below. Patient or Disease Mortality CVA Mediastinitis Characteristic Score Score Score Age 60 – 69 2 3.5 Age 70 –79 3 5 Age ⱖ 80 5 6 Female Sex 1.5 EF ⬍ 40% 1.5 1.5 2 Urgent surgery 2 1.5 1.5 Emergency surgery 5 2 3.5 Prior CABG 5 1.5 PVD 2 2 Diabetes 1.5 Dialysis or creatinine ⱖ2 4 2 2.5 COPD 1.5 3.5 Obesity (BMI 31–36) 2.5 Severe obesity (BMI ⱖ 37) 3.5 Total Score Perioperative Risk Total Score Mortality % CVA % Mediastinitis % 0 0.4 0.3 0.4 1 0.5 0.4 0.5 2 0.7 0.7 0.6 3 0.9 0.9 0.7 4 1.3 1.1 1.1 5 1.7 1.5 1.5 6 2.2 1.9 1.9 7 3.3 2.8 3.0 8 3.9 3.5 3.5 9 6.1 4.5 5.8 10 7.7 ⱖ6.5 ⱖ6.5 11 10.6 12 13.7 13 17.7 14 ⱖ28.3
Estimating the Risk of Mortality and Morbidity for Patients Being Considered for CABG Surgery Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA Practice Guidelines for Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 1999;34: 1262–347. Based on readily available clinical information, physicians and other caregivers can estimate an individual patient’s perioperative risk of death, stroke or deep sternal wound infection. This tool is readily usable at the bedside when answering the patient’s question, “what are my risks?”
ACC CURRENT JOURNAL REVIEW Jan/Feb 2001 © 2001 by the American College of Cardiology Published by Elsevier Science Inc.
22
1062-1458/01/$20.00 PII S1062-1458(00)00203-8
Preoperative Estimation of Risk of Mortality, Cerebrovascular Accident, and Mediastinitis For use only in isolated CABG surgery Directions: Locate outcome of interest, eg, mortality. Use the score in that column for each relevant preoperative variable, then sum these scores to get the total score. Take the total score and look up the approximate preoperative risk in the table below. Patient or Disease Mortality CVA Mediastinitis Characteristic Score Score Score Age 60 – 69 2 3.5 Age 70 –79 3 5 Age ⱖ 80 5 6 Female Sex 1.5 EF ⬍ 40% 1.5 1.5 2 Urgent surgery 2 1.5 1.5 Emergency surgery 5 2 3.5 Prior CABG 5 1.5 PVD 2 2 Diabetes 1.5 Dialysis or creatinine ⱖ2 4 2 2.5 COPD 1.5 3.5 Obesity (BMI 31–36) 2.5 Severe obesity (BMI ⱖ 37) 3.5 Total Score Perioperative Risk Total Score Mortality % CVA % Mediastinitis % 0 0.4 0.3 0.4 1 0.5 0.4 0.5 2 0.7 0.7 0.6 3 0.9 0.9 0.7 4 1.3 1.1 1.1 5 1.7 1.5 1.5 6 2.2 1.9 1.9 7 3.3 2.8 3.0 8 3.9 3.5 3.5 9 6.1 4.5 5.8 10 7.7 ⱖ6.5 ⱖ6.5 11 10.6 12 13.7 13 17.7 14 ⱖ28.3
Estimating the Risk of Mortality and Morbidity for Patients Being Considered for CABG Surgery Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA Practice Guidelines for Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 1999;34: 1262–347. Based on readily available clinical information, physicians and other caregivers can estimate an individual patient’s perioperative risk of death, stroke or deep sternal wound infection. This tool is readily usable at the bedside when answering the patient’s question, “what are my risks?”
ACC CURRENT JOURNAL REVIEW Jan/Feb 2001 © 2001 by the American College of Cardiology Published by Elsevier Science Inc.
22
1062-1458/01/$20.00 PII S1062-1458(00)00203-8