Table 1.
Risk assessment combining STS risk estimate, frailty, major organ system dysfunction, and procedure-specific impediments4
| Low risk (must meet all criteria in this column) | Intermediate risk (any 1 criterion in this column) | High risk (any 1 criterion in this column) | Prohibitive risk (any 1 criterion in this column) | |
|---|---|---|---|---|
| STS PROMa | <4% AND | 4–8% OR | >8% OR | Predicted risk with surgery of death or major morbidity (all-cause) >50% at 1 year OR |
| Frailtyb | None AND | 1 Indice (lieve) OR | ≥2 Indices (moderate-severe) OR | |
| Major organ system compromise not to be improved postoperativelyc | None AND | 1 Organ system OR | No more than 2 organ system OR | ≥3 Organ system OR |
| Procedurespecific impedimentd | None | Possible | Possible | Severe |
aUse of the STS PROM to predict risk in a given institution with reasonable reliability is appropriate only if institutional outcomes are within 1 standard deviation of STS average observed/expected ratio for the procedure in question.
bSeven frailty indices: Katz activities of daily living (independence in feeding, bathing, dressing, transferring, toileting, and urinary continence) and independence in ambulation (no walking aid or assist required or 5 m walk in < 6 s). Other scoring systems can be applied to calculate no, mild-, or moderate-to-severe frailty.
cExamples of major organ system compromise: Cardiac—severe LV systolic or diastolic dysfunction or RV dysfunction, fixed pulmonary hypertension; CKD Stage 3 or worse; pulmonary dysfunction with FEV1 <50% or DLCO2 <50% of predicted; CNS dysfunction (dementia, Alzheimer’s disease, Parkinson’s disease, CVA with persistent physical limitation); GI dysfunction—Crohn’s disease, ulcerative colitis, nutritional impairment, or serum albumin <3.0; cancer—active malignancy; and liver—any history of cirrhosis, variceal bleeding, or elevated INR in the absence of VKA therapy.
dExamples include tracheostomy present, heavily calcified ascending aorta, chest malformation, arterial coronary graft adherent to posterior chest wall, and radiation damage.
CKD, chronic kidney disease; CNS, central nervous system; CVA, stroke; DLCO2, diffusion capacity for carbon dioxide; FEV1, forced expiratory volume in 1 s; GI, gastrointestinal; INR, international normalized ratio; LV, left ventricular; PROM, predicted risk of mortality; RV, right ventricular; STS, Society of Thoracic Surgeons; and VKA, vitamin K antagonist.