VQI prohibitive risk

Q: What is a prohibitive risk in vascular surgery?

Answer: Patients with high mortality where less invasive intervention is preferred 

There are a few risk calculators to estimate the risk of perioperative vascular morbidity and mortality. The updated guidelines from the Society for Vascular Surgery (SVS) endorse the use of a scoring system based on data from the Vascular Study Group of New England, part of the National Vascular Quality Initiative (VQI). 

Per the VQI risk calculator, there are four risk categories: low, moderate, high, and prohibitive.

There have been further sub-group categories, such as 

• Respiratory Risk Groups (RAE): Low, Intermediate-Low, Intermediate-High, and High.
• Cardiac Risk Index (VQI CRI): Predicts myocardial infarction based on pre-operative patient characteristics and procedure type (CEA, EVAR, INFRA, SUPRA, OAAA).
• Frailty Assessment (VQI-FS): Uses seven variables (CHF, renal impairment, COPD, non-home dwelling, non-ambulatory, anemia, underweight) to predict 9-month mortality.
• Adverse Outcomes Categories (General): Used in research, these include 1-year follow-up, 30-day mortality, composite perioperative adverse events, and 12-month mortality.

Calculators are available at: https://www.vqi.org/

#surgical-critical-care

References:

1. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2.

2. Cronenwett JL, Kraiss LW, Cambria RP. The Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg. 2012 May;55(5):1529-37. doi: 10.1016/j.jvs.2012.03.016. PMID: 22542349.

3. Bertges DJ, Neal D, Schanzer A, Scali ST, Goodney PP, Eldrup-Jorgensen J, Cronenwett JL; Vascular Quality Initiative. The Vascular Quality Initiative Cardiac Risk Index for prediction of myocardial infarction after vascular surgery. J Vasc Surg. 2016 Nov;64(5):1411-1421.e4. doi: 10.1016/j.jvs.2016.04.045. Epub 2016 Jul 19. PMID: 27449347; PMCID: PMC5079798.