Case presentation consult from surgery- 51y female 51y female with Traumatic Brain injury @ 12yo Obese (BMI > 40) HTN- well-controlled on lisinopril 40mg/d OSA Chronic cough + intermittent hemoptysis Extensive pulmonary w/u normal to date (PFT+bronch) Hx of left fem/pop DVT ~9mo ago
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August Hein, M.D.
LtCol USAF, MC, SFS
*Cardiac event = fatal and non-fatal MI
15 April 2004
Poor exercise capacity: < four level blocks or two flights of stairs
Total: 20% vs 10%
Cardiac: 10% vs 5%
Pulmonary: 9% vs 6% (not statistically signif.)
Studies that show increased RR tend to not use multivariate analysis
Multiple factors present, not a good sole criterion for withholding surgery
FBS/FBG/FSG – or just serum glucose
Not recommended for surgical screening
**Recent control hx imperative for diabetics**
LFT – only if history/exam suggest disease
PT/PTT – low correlation of abnl to postop comp.
“perfectly unhelpful” predictor
+ likelihood ratio 0.0
- likelihood ratio 1.01
Clinical variable Points
High-risk surgery (i.e., intraperitoneal, intrathoracic, or suprainguinal vascular surgery) 1
Coronary artery disease 1*
Congestive heart failure 1
History of CVD 1
Insulin for diabetes mellitus 1
Preoperative SCr > 2.0 mg/dL 1 Total:__1__
*- MI, PE, VF, cardiac arrest, or complete heart block.