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Triage guidelines

Triage guidelines
Patients for low risk procedures typically done with sedation
  • In-person evaluation well before the day of surgery is recommended for patients with any one of the conditions from List 1
Triage guidelines for moderate-high risk procedures
  • In-person evaluation well before the day of surgery is recommended for patients with any one of the conditions from List 1 or List 2
List 1:
  1. Poor historians who do not know their medications or medical history
  1. Unable to lie flat and still for the duration of the procedure
  1. Obstructive sleep apnea without treatment
  1. BMI >40
  1. Heart failure
  1. Pacemaker or implantable cardiac defibrillator
  1. Hospitalization for medical problems within the last two months
  1. Unable to perform activities of daily living (feeding or dressing oneself)
  1. Myocardial infarction within the last 60 days
  1. Coronary stents within the last six months
  1. Stroke or TIA within the last three months
  1. Use of anticoagulants if these must be stopped for the procedure
  1. Oxygen use
  1. Previous serious problems with anesthesia such as malignant hyperthermia, nerve damage
  1. Dialysis patient
  1. Severe liver disease
  1. Cannot hear, speak, or understand English
  1. Significant dementia or cognitive impairment
  1. Pregnancy (unless procedure is a termination)
  1. Obviously difficult airway or history of same
  1. Poorly controlled hypertension (SBP >160; DBP >100)
  1. Poorly controlled seizure disorder
  1. Pulmonary hypertension
  1. Significant airway abnormalities (goiter, tumors, tracheostomy)

25.  Hospitalization within the last two months unless the surgery was planned during the hospitalization
List 2:
  1. Age >65 years
  1. Taking >8 prescription medications
  1. Heart disease of any type
  1. Medical condition inhibiting normal daily activity
  1. Inability to climb one flight of stairs
  1. Conditions necessitating assistance or monitoring at home within last three months
  1. Diabetes mellitus
  1. Chronic pain
  1. Kidney disease
  1. Liver disease
  1. Significant lung disease (use of daily medications)
  1. Likely to require a blood transfusion
  1. Patient refusing blood transfusion
  1. Planned postoperative ICU admission
  1. Previous transplant
  1. Significant spine disease (eg, scoliosis or neurologic symptoms)
  1. Rheumatoid arthritis
  1. Chemotherapy or radiation therapy within the previous three months
  1. Active cancer
  1. Thyroid disease
  1. Adrenal disease
  1. Neurologic disease (seizure, paralysis)
  1. Chronic obstructive lung disease
  1. Muscular dystrophies
This table shows suggested criteria for triaging patients for preanesthesia evaluation prior to or on the day of surgery. For further information, refer to UpToDate content on preanesthesia evaluation for noncardiac surgery.
BMI: body mass index; TIA: transient ischemic attack; SBP: systolic blood pressure; DBP: diastolic blood pressure: ICU: intensive care unit.
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