[Marburg model for optimization of stratification of the anaesthesiological risk]. / Marburg-Modell zur Optimierung der Stratifizierung des anästhesiologischen Risikos.

The perioperative risk is mostly determined by the patient's cardiological condition and the type of surgical intervention. Therefore it is very important during the premedication visit to identify patients with cardiac risk factors. We suggest that patients be classified into three risk classes according to the ACC/AHA recommendations in advance of the preanaesthetic visit. The majority of patients with a low or medium anaesthesiological risk profile could be identified by simple asking, e.g. whether they are able to exercise physically for 20 min or to climb two staircases without resting. For the lowest risk no further evaluation is necessary. For the medium risk class an additional preoperative diagnosis or for the higher risk class a cardiological consultation or even postoperative intensive care monitoring could be necessary. The aim of such a system is to always minimise the rate of perioperative complications and delays in scheduled surgery.

[Premedication visits. Economizing at the cost of the patient?]. / Prämedikationsvisite. Kosten sparen auf Kosten des Patienten?

The older the patient, the higher the risk of perioperative cardiac complications. Therefore, patients at risk have to be identified and the appropriate diagnostic or therapeutic measures initiated. The most important factor in this context is whether a planned surgery can be postponed. Several strategies have been developed (e.g. Goldman index, Eagle criteria) and the American Heart Association (AHA/ACC) has produced guidelines concerning perioperative diagnosis and therapy of cardiac risk patients. The common goal of these strategies is always the risk classification of the patient by combining the operative risk and the risk factors of the patient. The further procedure (diagnostic or therapeutic measures) is based on the risk classification. If further invasive therapy proves to be necessary, the determining factor is the period of time for which the operation can be delayed. This appears to be about 3 months but if this is not possible the outcome could be improved with a beta-blocker therapy in advance. A working group from the university hospital in Marburg has developed a strategy for risk classification and further diagnostic and therapeutic measures as outlined in this article.