The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

Moran, Peter; Ghidella, T.; Power, Gerald; Jenkins, Alicia J.; Whittle, D.

doi:10.1177/0310057x0803600205

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…Larger, varied, validation groups will also help determine the value of this and subsequent versions of the POM score. This type of scoring system may assist in providing progressive estimates of risk and assist in identifying patients requiring escalated care 15,17 . While the risk of the surgical procedure and urgency should be considered for every case, patient factors will often be more important.…”

Section: Discussionmentioning

confidence: 99%

“…The Goldman Cardiac Risk Index has been revised 15 with six variables and a simple cumulative score. The ongoing popularity of the Revised Goldman Cardiac Risk Index 16 highlights the advantages to clinicians of a risk score with a small number of variables, that is simple to calculate but has reasonable ability to discriminate for the outcome measured 10,17 . However, the Revised Goldman Cardiac Risk Index assesses the risk of cardiac complications, rather than all cause 30-day mortality which is an internationally recognised surgical outcome measure 3 .…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients

Story

Fink

Leslie

et al. 2009

Anaesth Intensive Care

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We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. We included 1012 patients and the 30-day mortality was 6%. The three preoperative factors and risk scores were ("three A's"): 1) age, years: 70 to 79=1, 80 to 89=3, 90+=6; 2) ASA physical status: ASA I or II=0, ASA III=3, ASA IV=6, ASA V=15; and 3) preoperative albumin <30 g/l=2.5. The three postoperative factors and risk scores were ("three I's") 1) unplanned intensive care unit admission=4.0; 2) systemic inflammation=3; and 3) acute renal impairment=2.5. Scores and mortality were: <5=1%, 5 to 9.5=7% and ≥10=26%. We also used a preliminary validation cohort of 256 patients from a regional hospital. The area under the receiver operating characteristic curve (C-statistic) for the derivation cohort was 0.80 (95% CI 0.74 to 0.86) similar to the validation C-statistic: 0.79 (95% CI 0.70 to 0.88), P=0.88. The Hosmer-Lemeshow test (P=0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients

Story

Fink

Leslie

et al. 2009

Anaesth Intensive Care

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“…The revised cardiac risk index (RCRI) is used by anesthesiologists and surgeons to assess the perioperative CVR in patients who undergo noncardiac surgery. Parameters included in the evaluation are age over 70 years, estimated risk of surgery, history or presence of IHD (MI or history of AP), congestive heart failure (HF), HT with signs of left ventricular hypertrophy (LVH), presence of Q waves or ischemic ST changes on resting electrocardiogram (ECG) cerebrovascular disease (CVD), the presence of DM (treated with insulin, additional risk) and renal failure (e.g., Table 1) [4,12,13]. The presence of more than one of these six independent predictors of cardiac complications following surgery is mandatory for further investigation.…”

Section: Several Clinical Risk Assessment Scores For Postoperative Camentioning

confidence: 99%

Cardiovascular Risk Evaluation in Patients with Critical Leg Ischemia before Vascular Surgery

Stoia¹,

Mocan²,

Goidescu³

et al. 2018

Peripheral Arterial Disease - A Practical Approach

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Assessment of the role and investigation particularities (comparative and complementary aspects, hierarchies, preferential indication) adapted to the context of a global cardiovascular (CV) evaluation, including clinical elements, non-invasive and invasive imagistic examination in order to estimate the cardiovascular risk (CVR) and to define the revascularization therapeutic strategy in patients with critical leg ischemia (CLI). Complete and accessible evaluation involves accessible means of investigation like clinical exam, electrocardiogram, cardiac biomarkers, arterial, cardiac, and carotid ultrasonography which could be affordable in all cardiovascular departments. Non-invasive stress tests, coronary and arterial cervical angiography imaging leads in selected cases and where is possible to the identification of significant coronary and/or carotid lesions potential responsible for cardiac and cerebrovascular events after vascular surgery. The evaluation algorithm allows better risk stratification of patients with CLI in high and intermediate CVR. The "poly-arterial" status in patients with CLI changes the intervention management with a more intensive pre-operative medical treatment, while the coronary and the carotid arteries revascularization might precedes the peripheral arterial revascularization procedures, in order to reduce the CV risk status.

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“…Spezifischere Scores, wie z. B. der Revised Cardiac Risk Index (rCRI, [68]) oder seine modifizierte Variante (mrCRI, [35]), erfassen das perioperative kardiale Risiko relativ zuverlässig [3,81]. Durch die Kombination mit der Dokumentation von metabolischen Äquivalenten (MET) wird der prädiktive Wert noch weiter gesteigert [9,120].…”

Section: Herzerkrankungunclassified

Perioperative risk and mortality after major surgery

et al. 2015

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Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term "failure to rescue" (FTR), i.e., the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.

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The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

Cited by 10 publications

References 16 publications

Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients

Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients

Cardiovascular Risk Evaluation in Patients with Critical Leg Ischemia before Vascular Surgery

Perioperative risk and mortality after major surgery

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