Run the List Perioperative Risk and Management
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Jun 9, 2025 Dr. Michael Janjigian, an associate professor at NYU and expert in perioperative medicine, joins Dr. Emily Gutowski to delve into preoperative assessments. They discuss recent updates to management guidelines and the use of cardiac risk scores, such as RCRI and Gupta. Insights are shared on the importance of evaluating comorbidities and readiness for surgery, including the role of BNP levels. The conversation emphasizes a multidisciplinary approach and the necessity of teamwork in optimizing surgical outcomes, making complex topics accessible for all.
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Stepwise Cardiac Risk Approach
- Use a stepwise approach for preoperative cardiac risk assessment following the ACC/AHA 2024 guidelines.
- Assess if surgery is emergent, check for active cardiac conditions, then estimate cardiac risk with validated tools.
Use Gupta & RCRI Scores
- Use the Gupta or RCRI score to estimate perioperative cardiac risk; less than 1% risk indicates low risk.
- Consider chronic disease risk modifiers like severe valvular disease or pulmonary hypertension before proceeding.
Functional Status Guides Surgery
- Assess patient's functional status in METs; >4 METs allows proceeding with surgery even if cardiac risk is elevated.
- Define 4 METs as walking two city blocks or a flight of stairs at a normal pace.