Does the patient present with comorbidity known to increase operative risk?
Neurological, pulmonary, vascular, and renal pathology are known determinants of operative risk. A history of previous stroke and increased age are the most important predictors of perioperative stroke which also carries a high mortality. A history of transient ischemic attack and known cerebrovascular disease are also significant risk factors. The presence of asthma requiring medication, known chronic obstructive pulmonary disease, or current smoking increases the probability of bronchopneumonia and ventilator dependency. Renal impairment invariably worsens temporarily after cardiac surgery, and artificial renal support may be required. All these factors are liable to prolong intensive care stay, increase the likelihood of sepsis, and produce a catabolic state which is particularly poorly tolerated in the elderly. In the very elderly, any of these factors is a strong contraindication to cardiac surgery. What is the patients biological age? Clinicians of all specialties are aware of po
