What are the implications of a Mutch score of 25.7 and a McCann score of 30.6 for surgical risk and management?

Mutch and McCann Scores: Surgical Risk Assessment and Management

I cannot provide a definitive recommendation because the Mutch score of 25.7 and McCann score of 30.6 you've referenced do not correspond to any validated surgical risk assessment tools in the medical literature or guidelines provided.

Critical Issue with the Scores Mentioned

The "Mutch score" and "McCann score" as described do not exist as recognized perioperative risk stratification instruments in current medical practice. After thorough review of the evidence provided, including multiple cardiovascular and perioperative guidelines from the American Heart Association, American College of Cardiology, and British Journal of Anaesthesia, these specific scoring systems are not referenced 1, 2.

Validated Risk Assessment Tools You Should Use Instead

For perioperative cardiac risk assessment, the following evidence-based tools are recommended:

Primary Risk Stratification

• The Revised Cardiac Risk Index (RCRI) is the most widely validated tool for predicting major adverse cardiac events post-operatively, with scores ranging from 0 (low risk) to ≥3 factors (high risk) 2
• The American College of Surgeons NSQIP MICA (MI and cardiac arrest) risk calculator may provide superior discrimination in certain populations 2
• The STS (Society of Thoracic Surgeons) score is reasonable to calculate for patients with complex coronary artery disease undergoing revascularization, with scores >5% indicating significantly increased operative mortality risk 1

RCRI Components to Assess

The six independent predictors you should evaluate include: history of ischemic heart disease, history of heart failure, history of cerebrovascular disease, preoperative insulin treatment for diabetes, preoperative renal dysfunction, and high-risk surgery 2

Possible Confusion with Other Scoring Systems

The research evidence mentions a "McCann" author in the context of substance use disorder trials, but this refers to a statistical methodology (NOBWOS scores), not a surgical risk assessment tool 3. This is completely unrelated to perioperative risk stratification.

Recommended Approach for Your Patient

Without knowing the actual validated risk scores, I recommend:

• Calculate the RCRI score immediately using the six validated predictors 2
• If RCRI ≥3, implement comprehensive cardiac monitoring and consider surveillance for myocardial injury after noncardiac surgery 2
• Assess functional capacity using the Duke Activity Status Index (DASI), as inability to achieve 4 METs indicates increased perioperative cardiovascular risk 2
• Consider measuring B-type natriuretic peptide levels for additional risk stratification beyond standard scores 2

Perioperative Blood Pressure Management

• Maintain systolic blood pressure between 90-160 mmHg (or within 70-140% of baseline) 4
• Keep mean arterial pressure ≥60-65 mmHg to reduce cardiovascular, cerebrovascular, and renal complications 4
• Systolic BP <90 mmHg is associated with increased risk of death, myocardial injury, stroke, and acute kidney injury and requires immediate intervention 1, 4

Please verify the scoring systems you're referencing and provide the correct validated risk assessment tools for accurate clinical guidance.