6. More Lee Goldman
Let me say one more thing about Lee Goldman's study. Many people
have done epidemiologic studies of patients coming for non-cardiac
surgery. They always find that old, sick people, do poorly. The
specific risk factor, such as the duration of time since the myocardial
infarction, may change a bit or not be significant. The absence
of a specific risk factor in an epidemiologic study does not mean
that the risk factor is no longer important. In an epidemiologic
study, there may not be enough patients, or more likely, no one
is stupid enough to anesthetize a lot of patients with critical
aortic stenosis, an MI last week, in CHF, for elective breast augmentation.
Individual risk factors can change over time if doctors change
who they operate on. It doesn't mean that it is OK to do elective
cases in patients who are acutely ill with a recent MI, CHF, or
critical aortic stenosis. Old sick people still do poorly.
Goldman, L., et. al.
Multifactorial index of cardiac risk in noncardiac surgical procedures,
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