Procedure-specific Risk Factors

Every procedure elicits a stress-response, i.e., “surgical stress,” characterized by physiological (i.e., autocrine, endocrine, and paracrine) changes accompanied by psychological reactions (e.g., fear, anxiety, anger, tension, malaise or fatigue).11 The magnitude of these procedure-related responses is proportional to the severity of tissue trauma, duration of the procedure, volume of blood loss, fluid shifts, and changes in core body temperature.11

Based on the above criteria, procedure-related stress can be classified as high, intermediate, and low with estimated rates of associated major medical events of >5%, 1-5%, and <1%, respectively (Box B).12 With low-stress procedures (e.g., dental procedures), the risk is negligible unless strong patient-specific risk factors are present. OHCP must identify patent-specific risk factors that may lead to medical emergencies during the perioperative period.

Box B. Procedure-related stress estimates.12

High-stress ProceduresIntermediate-stress ProceduresLow-stress Procedures
  • Aortic and other major vascular surgery
  • Peripheral vascular surgery
  • Neurological
  • Pulmonary
  • Major orthopaedic (hip, spine)
  • Renal transplantation
  • Head and neck surgery
  • Breast surgery
  • Dental procedures
  • Eye surgery
  • Gynecological procedures
  • Minor orthopaedic procedures
  • Minor urological surgery