
File CARDIAC_SURGERY_RISK_ASSESSMENT(694.5) Data List
| DATE OF PHYSICIAN'S ESTIMATE |
PATIENT |
ON VENTILATOR (48 HRS OR MORE) |
COMA (24 HRS OR MORE) |
STROKE |
PTCA |
LV CONTRACTION SCORE |
ELECTROPHYSIOLOGIC PROCEDURE |
PHYSICIAN ESTIMATE DATE |
PHYSICIAN'S ESTIMATE |
HOSPITAL OF SURGERY |
DIABETES |
COPD |
CIGARETTE SMOKING (PACK YEARS) |
CURRENT SMOKER |
ACTIVE ENDOCARDITIS |
I.V. NTG PREOPERATIVELY |
ANGIOPLASTY |
PRIOR HEART SURGERY |
HISTORY OF CHF |
CURRENT DIGITALIS USE |
AGE |
CURRENT DIURETIC USE |
PERIPHERAL VASCULAR DISEASE |
CEREBRAL VASCULAR DISEASE |
PRIOR MYOCARDIAL INFARCTION |
PRIOR MI |
PREOPERATIVE IABP |
UNSTABLE ANGINA |
NYHA FUNCTIONAL CLASS |
HYPERTENSION |
PULMONARY RALES |
RESTING ST-SEGMENT DEPRESSION |
HT (IN) |
CARDIOMEGALY BY CHEST X-RAY |
PLEURAL EFFUSION |
SERUM CREATININE (MG/DL) |
ROOM AIR PaO2 |
FEV1 |
LV SYSTOLIC PRESSURE (mm Hg) |
AORTIC SYSTOLIC PRESSURE |
PA SYSTOLIC PRESSURE (MM HG) |
MEAN PA WEDGE PRESSURE (MM HG) |
MEAN RA PRESSURE (mm Hg) |
HT (CM) |
LV END-DIASTOLIC PRESSURE |
WT (LBS) |
LV EJECTION FRACTION |
PROXIMAL ANTERIOR SEGMENT |
MIDANTERIOR SEGMENT |
APEX |
MIDINFERIOR SEGMENT |
PROXIMAL INFERIOR SEGMENT |
LEFT MAIN CORONARY STENOSIS |
NUMBER OF MAJOR CORONARIES |
LEFT ANT. DESC. STENOSIS |
LEFT ANT. DESC. DISTAL DISEASE |
RIGHT CORONARY STENOSIS |
WT (KG) |
R. COR. DISTAL VES. DISEASE |
CIRCUMFLEX CORONARY STENOSIS |
CIRC. COR. DISTAL VES. DISEASE |
GENERAL MEDICAL CONDITION |
PRIORITY OF SURGERY |
ESTIMATE OF MORTALITY |
INTENDED OPERATIVE PROCEDURE |
DATE/TIME SURGERY BEGAN |
BYPASS GRAFTS WITH VEIN |
BYPASS GRAFTS WITH ARTERY |
GREAT VESSEL REPAIR W BYPASS |
BODY SURFACE AREA |
CARDIAC TRANSPLANT |
MITRAL VALVE REPLACEMENT |
AORTIC VALVE REPLACEMENT |
TRICUSPID VALVE REPLACEMENT |
VALVE REPAIR |
LV ANEURYSECTOMY OR PLICATION |
OTHER PROCEDURE(S) |
TOTAL CROSS CLAMP TIME |
TOTAL CIRCULATORY ARREST |
INTEROPERATIVE USE OF BALLOON |
OPERATIVE DEATH |
DATE OF OPERATIVE DEATH |
POSTOPERATIVE IABP |
PERIOPERATIVE MYOCAR. INFARC. |
ENDOCARDITIS |
RENAL FAILURE |
LOW CARDIAC OUTPUT |
MEDIASTINITIS |
REOPERATION FOR BLEEDING |
REPEAT CARDIOPULMONARY BYPASS |