Table 3.1-7. Perioperative bleeding risk categoriesa

Surgery/procedure

Minimal bleeding risk

High bleeding risk

Gastrointestinal and genitourinary procedures

– Colonoscopyb

– Gastroscopyb

– Sigmoidoscopyb

– Capsule endoscopyc

– Push enteroscopy

– Barrett esophagus ablation

Major abdominopelvic surgery: hepatobiliary cancer resection, pancreatic cancer or pseudocyst resection, colorectal and gastric cancer resection, diverticular disease resection, inflammatory bowel disease resection, renal cancer resection, bladder cancer resection, endometrial cancer resection, ovarian cancer resection, radical prostatectomy

 

Cardiac procedures

– Permanent pacemaker implantation or battery change

– Internal cardiac defibrillator implantation or battery change

– Atrioventricular node ablation

– Coronary artery angiography (radial approach)

Major cardiac surgery (coronary artery bypass, valve replacement or repair)

Major thoracic surgery

 

– Lobectomy, pneumonectomy

– Esophagectomy

Major vascular surgery

 

– Aortic aneurysm repair

– Aortobifemoral bypass, popliteal bypass

– Carotid endarterectomy

Major orthopedic surgery

 

– Hip arthroplasty or hip fracture repair

– Knee arthroplasty or tibial osteotomy

– Shoulder arthroplasty

– Metatarsal osteotomy

Other major cancer or reconstructive surgery

 

– Head and neck cancer surgery

– Reconstructive facial, abdominal, or limb surgery

Dental procedures

– Tooth extraction (≤2 extractions)

– Endodontic (root canal) procedure

 

Skin procedures

Skin biopsy

 

Eye procedures

Phacoemulsification (cataract)

 

Neuraxial anesthesia

 

Any surgery requiring neuraxial anesthesia or injection (including epidural)

Intracranial or neuraxial surgery

 

– Brain cancer resection

– Laminectomy or neuraxial tumor resection

– Intracranial (subdural, epidural) bleeding evacuation

a Examples of surgeries with minimal and high risk of bleeding. A low- to moderate-bleeding-risk surgery or procedure includes most surgeries that typically are <1 hour in duration and do not involve neuraxial anesthesia.

b Assuming no polypectomy is expected.

c Assuming no sphincterotomy is expected.