High Risk Anaesthetic Assessment

Cat 1 · 30 days

appointment within 30 calendar days. Patients who are having one of the following major surgeries confirmed within the next 30 days: Gastrointestinal: - Oesophagectomy (Ivor Lewis Procedure) - Liver Resection - Pancreatic Surgery Orthopaedic: - Major revision arthroplasty Neurosurgery: - Complex spinal surgery (>=3 levels, corpectomy, 2stage procedures, deformity correction) - Posterior fossa surgery Vascular: - Open abdominal aortic aneurysm (AAA) repair. - Major endovascular or hybrid aortic procedure with prolonged operative time (>3hrs surgery length) Urological: - Radical cystectomy with urinary diversion - Nephrectomy for large renal mass Oncological: - Major free flap reconstructions - Radical gynaecological oncology procedure involving 2 or more teams AND patient has any of the co-morbidities below: - Recent Ischemic Heart Disease (E.g ACS/coronary stents within past 6 months) - Severe valvular heart disease (SOB on exertion, aortic stenosis AVAV<1cm^2), HRrEF (<40%), hospitalization within past 6/12 for cardiac reasons - Recent Stroke within past 6 months - Cirrhotic Liver Disease - New diagnosis of DVT/PE within the past 6 months requiring anticoagulation - Neuromuscular disorders having moderate-high risk surgery - COPD/Emphysema/Asthma (requiring regular puffers, SOB with stairs), home oxygen, pulmonary hypertension. - Diabetes (on insulin), phaeochromocytoma - Transplant Recipients (for any surgery) - Congenital Heart Disease (for any surgery) - Patients with multiple comorbidities (≥2 of the above) undergoing moderate-risk surgery with expected hospital stay. - Referrals specifically requesting ‘Fitness for Surgery/Anaesthetic Review’ for the frail non ambulant patient for example.

Cat 2 · 90 days

Appointment within 90 calendar days. Patients who are waitlisted CAT 2 for one of the below major surgeries and one or more major organ dysfunction: Gastrointestinal: - Oesophagectomy (Ivor Lewis Procedure) - Liver Resection - Pancreatic Surgery Orthopaedic: - Major revision arthroplasty Neurosurgery: - Complex spinal surgery (>=3 levels, corpectomy, 2stage procedures, deformity correction) - Posterior fossa surgery Vascular: - Open abdominal aortic aneurysm (AAA) repair. - Major endovascular or hybrid aortic procedure with prolonged operative time (>3hrs surgery length) Urological: - Radical cystectomy with urinary diversion - Nephrectomy for large renal mass Oncological: - Major free flap reconstructions - Radical gynaecological oncology procedure involving 2 or more teams AND patient has any of the co-morbidities below: - Recent Ischemic Heart Disease (E.g ACS/coronary stents within past 6 months) - Severe valvular heart disease (SOB on exertion, aortic stenosis AVAV<1cm^2), HRrEF (<40%), hospitalization within past 6/12 for cardiac reasons - Recent Stroke within past 6 months - Cirrhotic Liver Disease - New diagnosis of DVT/PE within the past 6 months requiring anticoagulation - Neuromuscular disorders having moderate-high risk surgery - COPD/Emphysema/Asthma (requiring regular puffers, SOB with stairs), home oxygen, pulmonary hypertension. - Diabetes (on insulin), phaeochromocytoma - Transplant Recipients (for any surgery) - Congenital Heart Disease (for any surgery) - Patients with multiple comorbidities (≥2 of the above) undergoing moderate-risk surgery with expected hospital stay. - Referrals specifically requesting ‘Fitness for Surgery/Anaesthetic Review’ for the frail non ambulant patient for example.

Cat 3 · 365 days

appointment within 365 calendar days. Patients who are waitlisted CAT 3 for one of the below major surgeries and one or more major organ dysfunction: Gastrointestinal: - Oesophagectomy (Ivor Lewis Procedure) - Liver Resection - Pancreatic Surgery Orthopaedic: - Major revision arthroplasty Neurosurgery: - Complex spinal surgery (>=3 levels, corpectomy, 2stage procedures, deformity correction) - Posterior fossa surgery Vascular: - Open abdominal aortic aneurysm (AAA) repair. - Major endovascular or hybrid aortic procedure with prolonged operative time (>3hrs surgery length) Urological: - Radical cystectomy with urinary diversion - Nephrectomy for large renal mass Oncological: - Major free flap reconstructions - Radical gynaecological oncology procedure involving 2 or more teams AND patient has any of the co-morbidities below: - Recent Ischemic Heart Disease (E.g ACS/coronary stents within past 6 months) - Severe valvular heart disease (SOB on exertion, aortic stenosis AVAV<1cm^2), HRrEF (<40%), hospitalization within past 6/12 for cardiac reasons - Recent Stroke within past 6 months - Cirrhotic Liver Disease - New diagnosis of DVT/PE within the past 6 months requiring anticoagulation - Neuromuscular disorders having moderate-high risk surgery - COPD/Emphysema/Asthma (requiring regular puffers, SOB with stairs), home oxygen, pulmonary hypertension. - Diabetes (on insulin), phaeochromocytoma - Transplant Recipients (for any surgery) - Congenital Heart Disease (for any surgery) - Patients with multiple comorbidities (≥2 of the above) undergoing moderate-risk surgery with expected hospital stay. - Referrals specifically requesting ‘Fitness for Surgery/Anaesthetic Review’ for the frail non ambulant patient for example.