Preoperative Clearance

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Stepwise approach to preoperative cardiac assessment

Image:Preoperative Clearance.jpg

Cardiac Risk Stratification for Noncardiac Surgical Procedures

High (Reported cardiac risk often greater than 5%)

  • Emergent major operations, particularly in the elderly
  • Aortic and other major vascular surgery
  • Peripheral vascular surgery
  • Anticipated prolonged surgical procedures associated with large fluid shifts and/or blood loss

Intermediate (Reported cardiac risk generally less than 5%)

  • Carotid endarterectomy
  • Head and neck surgery
  • Intraperitoneal and intrathoracic surgery
  • Orthopedic surgery
  • Prostate surgery

Low (Reported cardiac risk generally less than 1%)

  • Endoscopic procedures
  • Superficial procedure
  • Cataract surgery
  • Breast surgery

Estimated Energy Requirements for Various Activities

1 MET Can you take care of yourself? 4 METs Climb a flight of stairs or walk up a hill?
Eat, dress, or use the toilet? Walk on level ground at 4 mph or 6.4 km per h?
Walk indoors around the house? Run a short distance?
Walk a block or two on level ground at 2 to 3 mph or 3.2 to 4.8 km per h?
Do heavy work around the house like scrubbing floors or lifting or moving heavy furniture?
Participate in moderate recreational activities like golf, bowling, dancing, doubles tennis, or throwing a baseball or football?
4 METs Do light work around the house like dusting or washing dishes?

Greater than 10 METs
Participate in strenuous sports like swimming, singles tennis, football, basketball, or skiing?
MET indicates metabolic equivalent.Adapted from the Duke Activity Status Index and AHA Exercise Standards.


  1. Eagle, K. A. et al. Circulation 2002;105:1257-1267
  2. Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989; 64: 651–4

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