Preoperative Risk Scores
Apfel, STOP-BANG and the Revised Cardiac Risk Index.
Apfel — postoperative nausea and vomiting
Select the predictors present
Two interventions from different pharmacological classes. Baseline risk reduction = propofol TIVA, no nitrous oxide, opioid-sparing and regional analgesia.
Apfel CC, et al. Anesthesiology 1999;91(3):693–700.
Gan TJ, et al. Fifth Consensus Guidelines for PONV. Anesth Analg 2025. doi:10.1213/ANE.0000000000007816
STOP-BANG — obstructive sleep apnoea
BMI, age and sex follow the patient strip until you override them.
Set weight, height, age and sex above to auto-fill BMI, age and sex
Select the items present
Chung F, et al. STOP questionnaire. Anesthesiology 2008;108(5):812–821 — the cut-offs scored here.
Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire. Chest 2016;149(3):631–638 — the current form asks neck as collar size by sex (≥ 43 cm men, ≥ 41 cm women); this page scores the 2008 single 40 cm cut-off, measured at the cricoid.
Risk bands: STOP-Bang questionnaire, F. Chung, University Health Network, Toronto.
RCRI — Revised Cardiac Risk Index
Select the predictors present
As published: high-risk surgery = intraperitoneal, intrathoracic or suprainguinal vascular. Ischaemic heart disease = prior MI, positive exercise test, current ischaemic chest pain, nitrates or pathological Q waves. Heart failure = pulmonary oedema, bilateral crackles or third heart sound, paroxysmal nocturnal dyspnoea, or redistribution on chest radiograph. Cerebrovascular disease = stroke or TIA. Creatinine above 2.0 mg/dl, that is above 177 µmol/l.
Duceppe E, et al. CCS perioperative cardiac risk guidelines. Can J Cardiol 2017;33(1):17–32. doi:10.1016/j.cjca.2016.09.008
Lee TH, et al. Circulation 1999;100(10):1043–1049 — validation cohort, elective major noncardiac surgery, age 50 yr and over.