Risk stratification is an important technique that allows patients to be classified according to their health risk status, taking into consideration many factors, such as diagnosis, age, BMI, comorbidities, labs and other assessment scores, health behaviors and health literacy, and social and caregiver support needs, to name a few. Utilizing such a framework or model can be used not only to identify patient-specific risks to refine treatment plants, but can also be applied to improve workflows, better manage population health, and effectively use resources.
For this Discussion, you will consider risk stratification in the preoperative environment.
Review each of the three patient scenarios provided. Identify each patient as high, intermediate, or low risk.
Consider patient education needs and strategies for each patient, as well as what the informed consent for each procedure would be.
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 5560% with no wall motion abnormality. She has no active anginal or exertional symptoms.
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