Surgery

Preoperative Evaluations

ASA Physical Status Classification

Class	Definition
1	Normal healthy
2	Mild systemic disease
3	Severe systemic disease
4	Life-threatening systemic disease
5	Moribund
6	Brain-dead

Metabolic Equivalent (MET)

Mallampati Classification

EuroSCORE

Score	Level	Mortality
0 ~ 2	Low	1.3%
3 ~ 5	Medium	2.9%
≥ 6	High	10.9 ~ 11.5%

Revised Cardiac Risk Index (RCRI)

• High-risk surgery :: vascular & thoracic
• Ischemic heart disease
• History of congestive heart failure (CHF)
• History of cerebrovascular disesase
• Insulin-dependent diabetes mellitus
• Preoperative creatinine > 2 mg/dL

Score	Level	Cardiac Risk
< 2	Low	< 1%
≥ 2	High	> 1%

Minimal Fasting Time

Product	Time
Clear liquid	2 hours
Human milk	4 hours
Light meal	6 hours
Regular meal	8 hours

Therapeutic Intervention Scoring System (TISS)

Acute Physiology and Chronic Health Evaluation (APACHE) II

• Temperature :: rectum
• Heart rate (HR)
• Mean arterial pressure (MAP)
• Respiratory rate (RR)
• Oxygenation: PaO₂/FiO₂ (PF) ratio
• Arterial pH
• Sodium
• Potassium
• Creatinine
• Hematocrit
• White blood cell count
• Glasgow Coma Scale (GCS)

Etiology of Postoperative Fever {5W}

Mnemonic	Etiology	Time (days)
Wind	Pneumonia & Atelectasis	1 ~ 3
Water	Sepsis & UTI	3 ~ 5
Wound	Surgical site infection (SSI)	5 ~ 7
Walking	DVT & PE	> 5
Wonder	Drugs	-

Surgical Wound Classification

Wound	Flora	Spillage	Inflammation	Pus
Clean	-	-	-	-
Clean-contaminated	+	-		-
Contaminated	+	+	+	-
Dirty	+	+	+	+

Types of Wound Healing

Types of Suture Materials

• Non-absorbable
  • Natural
    • Cotton
    • Silk
    • Steel
  • Synthetic
    • Nylon
    • Polypropylene
    • Polyester
• Absorbable
  • Natural
    • Collagen [Catgut]
  • Synthetic
    • Vicryl
    • Monocryl
    • Dexon
    • Polydioxanone (PDS)

Types of Wound Closure

• 1° closure [1° intent]
• 2° closure [2° intent]
• Delayed 1° closure [3° intent]

Tissue Reactions to Suture Materials

• Non-absorbable < Absorbable
• Natural > Synthetic
• Monofilament < Braided