ABCS Risk Assessment & Management 3 — Questions and Answers
Question 1: Which factor is the strongest independent predictor of postoperative pulmonary embolism following cosmetic surgery?
- Patient age over 40
- Concurrent multiple procedures with operative time exceeding 6 hours (Correct answer)
- Female sex
- General anesthesia versus sedation
Correct answer: Concurrent multiple procedures with operative time exceeding 6 hours
Prolonged operative time combined with multiple simultaneous procedures is among the strongest independent risk factors for VTE and PE after cosmetic surgery.
Question 2: A 35-year-old patient discloses she takes St. John's Wort daily. Which perioperative risk does this most directly raise?
- Hypertensive crisis during induction
- Induction failure due to anesthetic resistance
- Altered drug metabolism and potential serotonin syndrome with anesthetic agents (Correct answer)
- Postoperative hypothyroidism
Correct answer: Altered drug metabolism and potential serotonin syndrome with anesthetic agents
St. John's Wort induces CYP enzymes and can interact with anesthetic agents and opioids, raising the risk of serotonin syndrome and unpredictable drug levels.
Question 3: The Caprini Risk Assessment Model stratifies patients for perioperative:
- Cardiac arrest risk
- Venous thromboembolism risk (Correct answer)
- Airway management difficulty
- Infection and wound dehiscence
Correct answer: Venous thromboembolism risk
The Caprini score is a validated tool for stratifying VTE risk in surgical patients and guiding prophylaxis intensity.
Question 4: During blepharoplasty, a patient develops sudden bradycardia and hypotension after periorbital injection. The most likely cause is:
- Pulmonary embolism
- Oculocardiac reflex triggered by periorbital pressure or traction (Correct answer)
- Anaphylaxis to local anesthetic
- Spontaneous coronary artery dissection
Correct answer: Oculocardiac reflex triggered by periorbital pressure or traction
The oculocardiac reflex (trigeminovagal) is triggered by traction or pressure on periorbital structures and can cause bradycardia and hemodynamic compromise.
Question 5: In the informed consent process for rhinoplasty, which element specifically addresses risk management obligations?
- Documenting the patient's aesthetic goals
- Clearly disclosing material risks, alternatives, and the surgeon's revision policy (Correct answer)
- Recording the implant serial numbers
- Obtaining insurance pre-authorization
Correct answer: Clearly disclosing material risks, alternatives, and the surgeon's revision policy
Informed consent requires disclosure of material risks, alternatives, expected outcomes, and any limitations—this directly fulfills the surgeon's risk communication duty.
Question 6: A patient with a history of keloid scarring requests breast augmentation via inframammary incision. The best risk management approach is to:
- Proceed with the transaxillary approach only
- Document the keloid history, counsel extensively on scar outcomes, and consider a test site (Correct answer)
- Decline surgery as keloid history is an absolute contraindication
- Use absorbable sutures exclusively to minimize scar risk
Correct answer: Document the keloid history, counsel extensively on scar outcomes, and consider a test site
Thorough counseling, documented informed consent, and potentially a test wound or scar management protocol are appropriate risk mitigation steps in keloid-prone patients.
Question 7: Which postoperative sign in a facelift patient warrants immediate surgical re-exploration?
- Mild bruising and edema on postoperative day 1
- A rapidly expanding hematoma with skin color change and increasing pain (Correct answer)
- Mild tightness along the incision line
- Numbness over the cheek area
Correct answer: A rapidly expanding hematoma with skin color change and increasing pain
A rapidly expanding hematoma with skin changes suggests arterial bleeding and impending skin necrosis, requiring immediate operative drainage.
ABCS Risk Assessment & Management 3
Which factor is the strongest independent predictor of postoperative pulmonary embolism following cosmetic surgery?