Conditions / Medications
identified based on
patient chart review
ECG
CBC
(no diff)
BMP CMP Cr PT/INR PTT
Anemia (defined by Hct < 36
within past 12 months)
within 180 d
Bleeding disorder
results good for
30 d*
within 180 d within 180 d
Chronic kidney disease
GFR <60 ml/min
within
180 d
ESRD/Dialysis within 1 yr within 180 d
Tobacco use history > 20pk/yr within 1 yr
within
180 d
COPD within 1 yr
within
180 d
Pulmonary Fibrosis within 1 yr
within
180 d
Liver disease / Cirrhosis
within 30 d* within 30 d* within 30 d* within 30 d*
Untreated Obstructive Sleep
Apnea or StopBang 5+
within
180 d
H/o heart, lung, liver, pancreas,
kidney transplant
within 180 d within 180 d
Active hematologic malignancy
or chemotherapy/
radiation in last 30 d
within 30 d* within 30 d*
LIP Consult Other Tests / Notes
X
X
*without clinical change
X
Cirrhosis or Active Hepatitis
X
OTHER
CO-MORBID
CONDITIONS
X
For Stage 4 CKD or eGFR<30
For any procedure other than dialysis
access/declot
best to schedule surgery on
day after HD
Only surgery risk group 3 or 4 or for
anemia Hct <30 (non-ESRD)
X
X
