Cardiac Risk Factors and Complications in Non-Cardiac Surgery

Goldman, Lee; Caldera, Debra L.; Southwick, Frederick S.; Nussbaum, Samuel R.; Murray, Barbara E.; O’Malley, Terrence A.; Goroll, Allan H.; Caplan, Charles H.; Nolan, James; Burke, Donald S.; Krogstad, Donald J.; Carabello, Blasé A.; Slater, Eve E.

doi:10.1097/00005792-197807000-00006

Cited by 351 publications

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“…The overall rate of MCCs did not differ between the two studies ( Table 3). 4 Defined as history of congestive heart failure (CAIS), excluded pulmonary edema on chest x-ray, paroxysmal nocturnal dyspnea, physical exam showing bilateral rales or S3 gallop 5 Cardiovascular disease -defined as history of either stroke or transient ischemic attack (CAIS) 6 Defined as preoperative serum creatinine [ 176.6 mmolÁL -1 (CAIS) 7 Defined as history of hypertension (CAIS) or hypertension requiring medical control of blood pressure (CAIS) *''Other'' category composed of gastrointestinal, ear nose and throat, neurological surgeries A The Cockcroft-Gault equation is generated using age, weight, sex, and serum creatinine level glomerular filtration rate (GFR) = (140 -age 9 weight [kg] 9 constant) / serum creatinine (umolÁL The rates of MCCs in the original RCRI model were 0.4%, 1.1%, 4.6%, and 9.7% for 0, 1, 2, and C 3 points, respectively, with an AUC value of 0.78 (95% CI 0.73 to 0.82). The comparable rates using the CAIS data were 0.5%, 2.6%, 7.2%, and 14.4% risk of MCCs, respectively, for the same categories.…”

Section: Resultsmentioning

confidence: 99%

“…The ''revised'' nomenclature specified that the RCRI built on and simplified an earlier index. 7 The RCRI was derived from a cohort of 4,315 patients, where 2,893 were used to derive the index, i.e., the ''derivation set'', and 1,422 patients were assigned to the ''validation set''. The index is composed of six predictive factors: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine [ 177 mmolÁL -1 .…”

Section: Résumémentioning

confidence: 99%

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The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

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The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients L'indice de risque cardiaque modifié dans le nouveau millénaire: une réévaluation prospective et unicentrique de cohorte des variables originales chez 9519 patients consécutifs devant subir une chirurgie non urgente Abstract Purpose Cardiac complications following non-cardiac surgery are major causes of morbidity and mortality. The Revised Cardiac Risk Index (RCRI) has become a standard for predicting post-surgical cardiac complications. This study re-examined the original six risk factors to confirm their validity in a large modern prospective database.Methods Using the definitions in the original risk index, this study included 9,519 patients aged C 50 undergoing elective non-cardiac surgery with an expected length of stay C two days at two major tertiary-care teaching hospitals. The validity of the original predictors was tested in this population using binomial logistic regression modelling, area under the receiver operator curve (ROC) analysis, and the net reclassification index. Results Rates of major cardiac complications with 0, 1, 2, C 3 of the predictors were 0.5%, 2.6%, 7.2%, and 14.4%, respectively, in our patient cohort compared with 0.4%, 1.1%, 4.6%, and 9.7%, respectively, in the original cohort. Similar to the original report, binary logistic regression analysis showed that both preoperative treatment with insulin (odds ratio [OR] 1.4; 95% confidence interval [CI] 0.7 to 2.6) and preoperative creatinine [ 176.8 mmolÁL -1 (OR 1.7; 95% CI 0.8 to 3.6) did not improve the predictive ability of the index. Analysis of the remaining four factors resulted in an area under the curve (AUC) identical to that seen for the reconstructed six-factor RCRI (AUC = 0.79). We found that a Author contributions Christopher Davis organized and performed the analysis, wrote the first draft of the manuscript, and was responsible for major revisions to both the analysis and manuscript. Gordon Tait was responsible for creation of the database and the data integrity. He performed and or supervised quality checks on the data and helped perform the data analysis. Gordon Tait, Jo Carroll, and Duminda N. Wijeysundera made key revisions to the manuscript. Jo Carroll assisted in the creation of the database and quality control of the data. Duminda N. Wijeysundera and W. Scott Beattie were responsible in part for the concept of the study. Duminda N. Wijeysundera revised key aspects of the data analysis. W. Scott Beattie was responsible in part for supervision of the project. He obtained funding for the project, helped write all drafts of the manuscript, and made revisions to the data analysis. Dr. Beattie was Mr. Davis's summer elective supervisor. All authors have seen the data analysis and the revised manuscript and vouch for the authenticity of all aspects of this manuscript. glomerular filtration rate (GFR) \ 30 mLÁmin -1 was a better predictor of major...

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Section: Resultsmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Davis

Tait

Carroll

et al. 2013

Can J Anesth/J Can Anesth

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“…Incidence of peri-operative stroke associated with general surgery Whilst the reported incidence of peri-operative stroke associated with carotid artery surgery is Ϸ 5% [2,4,7], the incidence of peri-operative stroke [8][9][10][11][12] following general surgery is between 0.2% and 0.7% in patients without a previous history of cerebrovascular disease. It is difficult to obtain an accurate incidence of postoperative stroke in general surgical patients as the figure is influenced by the age structure of the study population.…”

Section: Significancementioning

confidence: 99%

Peri‐operative stroke in general surgical patients

1997

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“…In den letzten 20 Jahren wurden unter Zuhilfenahme der verfügba-ren Literatur und von mathematisch statistischen Berechnungsverfahren (Wahrscheinlichkeitstheorie) zahlreiche Klassifizierungen des perioperativen Risikos nach Punktesystemen eingeführt und kontinuierlich weiterentwickelt (5)(6)(7)(8)(9)(10)(11). Symptome oder Befunde, die statistisch mit einer erhöhten Komplikationsrate verbunden sind, erzielen einen hohen Punktewert.…”

Section: Punktesysteme Zur Risikoeinschätzungunclassified

Preoperative cardiovascular risk evaluation - diagnostics

Cremers

Maack

Böhm

2004

Dtsch med Wochenschr

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Die präoperative Risikoeinschätzung und Diagnostik hat nicht das primäre Ziel, einen Patienten als "operabel" oder "nicht operabel" zu klassifizieren, sondern die perioperative Morbidität und Sterblichkeit zu senken. Die wichtigsten perioperativen Risikofaktoren sind Herz-Kreislauferkrankungen. Diese sind präoperativ oft in einem vertretbaren Zeitraum zu diagnostizieren und zu behandeln. Erkennen des RisikopatientenDas perioperative Risiko wird durch vorbestehende Erkrankungen des Patienten sowie die Art des operativen Eingriffes bestimmt. Man spricht daher von patienten-bzw. operationsspezifischen Faktoren.

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Cardiac Risk Factors and Complications in Non-Cardiac Surgery

Cited by 351 publications

References 0 publications

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients

Peri‐operative stroke in general surgical patients

Preoperative cardiovascular risk evaluation - diagnostics

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