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 the risk stratification video in this week’s Learning Resources.
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.
Post your assessment of which level of risk each patient in the case scenarios corresponds with (high, intermediate, or low). Explain the rationale for your decision-making.
You are asked to evaluate a 49-year-old female set for preoperative or stratification for proposed laparoscopic shoulder surgery. She is active, participating in soccer both as a player and a coach several times a week. She has no cardiac history and no exertional symptoms.
Based on the information provided, this 49-year-old female would likely be classified as low risk for her proposed laparoscopic shoulder surgery. She is active and participates in soccer frequently, indicating good functional status. She has no reported cardiac history or exertional symptoms that might increase her surgical risk (Forbes and Hill, 2016).
Factors that contribute to low surgical risk include her relatively young age, lack of significant comorbid conditions, and good baseline functional status (Wijeysundera et al., 2018). Her risk of postoperative complications is likely minimal. However, a full preoperative assessment should still be completed, including any necessary diagnostic tests to confirm her overall health status.
Patient education should focus on typical recovery from laparoscopic shoulder surgery, including activity restrictions, pain management, and expectations for physical therapy. The informed consent should outline the risks specific to this procedure, which are generally low. These include the risk of bleeding, infection, damage to surrounding structures, and the possibility of conversion to an open approach if necessary (Namdari et al., 2014).
Overall, this patient can be considered low risk given her demographic factors and good health status. Thorough preoperative evaluation and optimization is still important, along with setting appropriate expectations for the typical postoperative course (Forbes and Hill, 2016). Careful patient selection and risk assessment helps ensure optimal outcomes.
References:
Forbes, J. and Hill, K., 2016. Preoperative assessment and premedication. Continuing Education in Anaesthesia Critical Care & Pain, 16(1), pp.12-15.
Wijeysundera, D.N., Beattie, W.S., Austin, P.C. and Hux, J.E., 2018. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study. Bmj, 360.
Namdari, S., Baldwin, K., Glaser, D. and Huffman, G.R., 2014. Does obesity affect early outcome of rotator cuff repair?. Journal of Shoulder and Elbow Surgery, 23(5), pp.650-654.
