cleared for surgery

After a patient sustains a hip fracture and is admitted to the hospital, and the family and patient have decided that they want to proceed with surgery, the patient needs to be CLEARED FOR SURGERY.

cleared for surgery

The American Society of Anesthesiologists has a five-part grading system for assessing the risk of surgery.  When the anesthesiologist interviews the patient and reviews the medical records, the patient is placed into one of the five following categories.

  • Class 1: a normal healthy patient
  • Class 2: a patient with mild systemic disease — such as asthma
  • Class 3: a patient with severe systemic disease — such as rheumatoid arthritis or cancer
  • Class 4: a patient with severe systemic disease that is a constant threat to life
  • Class 5: a dying patient who is not expected to survive for much longer without an operation

The majority of patients with a hip fracture are at least a class 3 and usually a class 4.  They often have a history of coronary artery disease, a prior stroke, have had major surgical operation like coronary artery bypass graft surgery or pacemakers implanted, and their care is complicated.  In the modern US medical system, these patients need to be “cleared for surgery” by an internal medicine physician or a hospitalist.  In practice, this usually means that all of their medical problems are adequately documented and everyone is aware that this patient has a high risk of major complications as the result of surgery.  In my experience, it is relatively rare that the patient is not cleared for surgery because the alternative is continued bed rest and a relatively rapid decline.  The take-home message that I try to convey to most families is, yes we can operate in most situations, but the risk is much higher taking care of an 80-year-old with a hip fracture than a 30-year-old with a hernia.  That being said, with modern anesthetic techniques, the rate of complications during the operation itself is still very low, and most of the problems seem to occur during the rehabilitation phase if the patient does not respond well to physical therapy or attempts at mobilization.

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