Hip Surgery Classification for Perioperative Risk Assessment
Left hip surgery is NOT considered intraperitoneal, intrathoracic, or suprainguinal vascular surgery according to established perioperative cardiac risk stratification systems 1, 2.
Surgical Risk Classification
Hip surgery, including total hip arthroplasty and hip fracture repair, is classified as orthopedic surgery in the ACC/AHA perioperative risk stratification framework 1.
Key Classification Points:
- Orthopedic procedures (including hip surgery) are categorized as intermediate-risk surgery with a reported cardiac risk generally between 1-5% 1
- The RCRI (Revised Cardiac Risk Index) specifically defines "high-risk surgery" as suprainguinal vascular, intraperitoneal, or intrathoracic surgery 1, 2
- Hip surgery does not meet any of these three criteria 1
RCRI Risk Calculation
For RCRI scoring purposes, hip surgery receives 0 points for the surgical risk factor 1, 2. The RCRI assigns 1 point only when the procedure is:
- Suprainguinal vascular surgery (aortic, iliac vessel procedures) 1, 2
- Intraperitoneal surgery (abdominal cavity procedures) 1
- Intrathoracic surgery (chest cavity procedures) 1
Clinical Context
While hip surgery doesn't qualify as "high-risk" by RCRI definition, certain patient populations undergoing hip procedures may still have elevated cardiac risk 1:
- Emergency hip fracture repair in overweight/obese patients shows increased cardiac complications compared to elective procedures 1
- Urgent hip fracture repair carries higher risk than elective total hip arthroplasty, though the surgery type itself remains classified as orthopedic 1
- Studies show hip surgery patients had perioperative MI rates of 0.03% in unselected populations, significantly lower than vascular surgery 1
Vascular Complications Distinction
Although rare vascular injuries can occur during hip surgery (external iliac artery injury in 0.01-0.1% of cases), these complications do not reclassify the procedure as vascular surgery 3, 4, 5. The procedure remains orthopedic in nature for risk stratification purposes 1.