Risk assessment combining STS risk estimate, frailty, major organ system dysfunction, and procedure-specific impediments

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; VKA: vitamin K antagonist.
* Use of the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) to predict risk in a given institution with reasonable reliability is appropriate only if institutional outcomes are within one standard deviation of STS average observed/expected ratio for the procedure in question.
¶ Seven 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-meter walk in <6 s). Other scoring systems can be applied to calculate no, mild-, or moderate-to-severe frailty.
Δ Examples 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.
◊ Examples: tracheostomy present, heavily calcified ascending aorta, chest malformation, arterial coronary graft adherent to posterior chest wall, or radiation damage.