Surgical risk

[LukeL]

I have a history of an orthopedic tumor condition (FD Cherubism) which according to medical literature should remain stable and even regress since I am past puberty. (22 years old) As a result my jaw is enlarged and I have severe dental problems, including the teeth, gums, and sof tissue. Two dentist have reccomended a complete reconstruction of my lower jaw with the possibility of replacing a good portion of the bone.

My question is with this kind of surgery what would the  risk of a cardiac event be, including an embolism? I have a history of severe anxiety and palpitations, but all echos, ekgs, holters, and blood work have shown nothing serious except mild LVH, with possible diastolic dysfuntion, evident on echo. But all wall motion and EF are normal.

Even though I have had well over one dozen surgeries in the past I have had none since 2000 and am really anxious about this. I know it will improve my life, I just  have a problem with being put under, even though I have had no bad expierence with anestheisa other then severe fatigue and nasuea for 2-3 days afterwards.

I guess what I am asking is, in a young patient with no major risk factors what are the odds of a major cardiopulmonary event during surgery? I am on toprolXL25mg 2X daily and paxil 40mg daily. Thank You

[Michael J. McWilliams, M.D.]

I am unfamiliar with that surgical procedure. I am sorry you have to have that done, it sounds like you have been through a lot of surgeries.  It does not sounds like high risk surgery and based on what you have told me, you would not likely need further medical evaluation to assess risk if you have a normal EKG and Echo and no other symptoms that localize to the cardiovascular system like chest pain, shortness of breath, leg swelling.  Unfortunately there are risks to every procedure, but you risks do not sound very high.
The risk of a 22 year old having a adverse cardiovascular event is probably 1% or less.  Please talk to your doctor about the risks before your procedures.  As I said above, I am not familiar with this procedure or its risks.

The algorhythm for risk assessment is in the link below, but I should warn you that it is not easy to understand.

I hope this helps.  Good luck with your surgery.

http://www.acc.org/qualityandscience/clinical/guidelines/perio/update/fig1.htm

http://www.acc.org/qualityandscience/clinical/guidelines/perio/update/figures.htm

[LukeL]

Just wanted to add if there is an algorithm you could direct me to I would appreciate it. Thank You