The Perioperative Cardiac Risk Assessment: Medical and Legal Details Beyond the Cardiac Risk Calculator
Received Date: November 07, 2019; Published Date: November 13, 2019
Cardiologists performing preoperative cardiac evaluations for non-cardiac surgery have a unique opportunity to assess and optimize the patient’s baseline and general health; determine the patient’s inherent surgical risk based upon a comprehensive history, physical examination and pertinent laboratory data; ensure the patient has made an informed choice regarding surgery, and identify post-operative risks that must be considered to reduce the potential for major adverse cardiovascular events. The introduction of perioperative risk calculators may have unintentionally reduced perioperative cardiac risk assessment into a singular thought process based upon a number generated by statistical analysis and computergenerated digit attempting to quantify risk. The displacement of the comprehensive clinical history and physical examination by an algorhythm may have negatively impacted our true risk assessment of patients undergoing surgery. The comprehensive subjective and objective evaluation allows appropriate decision-making regarding the proposed surgery and should allow accurate assessment of risks and have potential to reduce the patient’s cardiovascular risk. Additionally, there is always a small inherent risk in all surgical procedures and operations. When an adverse outcome occurs, there is potential for an allegation of negligence. Any allegation of negligence will result in a detailed autopsy of the medical record. The best defense to an allegation of negligence is a true physician–patient relationship and comprehensive documentation in the medical record of the patient’s assessment, clinical conditions impacting decision-making, and a detailed rational for the cardiologist’s management decisions.