Utilizing the Most Accurate Preoperative Risk Calculator.

Wasey Ali Yadullahi Mir,Francesco Fiumara,Suman Gaire,Dhan B Shrestha,Larissa Verda

doi:10.7759/cureus.17054

Abstract

The most commonly used preoperative assessment tools include the American College of Surgeons National Surgical Quality Improvement Program and the Revised Cardiac Risk Index. These tools seek to predict the risk of an individual experiencing postoperative complications, including but not limited to mortality, myocardial infarction, pneumonia, stroke, venous thromboembolism, and pneumonia. Many published studies have sought to objectively quantify the utility of the preoperative risk calculations by retrospectively compiling data for patients who underwent the same or comparable surgeries to compare actual complications to predicted complications. Therefore, we searched these studies to review the literature to draw more general conclusions and recommend which risk calculator is best for different types of surgeries.

Highlights

BackgroundPatients undergoing major noncardiac surgery are at an increased risk of perioperative cardiovascular events
In a study that included more than 10 million hospitalizations for major noncardiac surgery, the incidence of a major adverse cardiovascular and cerebrovascular event was found to be 3% [1]
Despite the low power of the former study, the NSQIP was described by Veeravagu et al to be effective for predicting adverse outcomes in patients undergoing spinal surgery, highlighting an area under the curve (AUC) of 0.669 in larger sample size [9]

Summary

Introduction

Patients undergoing major noncardiac surgery are at an increased risk of perioperative cardiovascular events. Despite the low power of the former study, the NSQIP was described by Veeravagu et al to be effective for predicting adverse outcomes in patients undergoing spinal surgery, highlighting an area under the curve (AUC) of 0.669 in larger sample size [9]. Carabini et al, utilizing a significantly larger study sample, reported the RCRI to be unreliable for predicting adverse outcomes in patients undergoing spinal fusion with instrumentation, reporting an AUC of 0.54 [17]. Kopec et al utilized high-sensitivity cardiac troponin T (hscTnT) combined with the RCRI, resulting in an AUC of 0.716 for patients undergoing major noncardiac. Golubovic et al utilized high-sensitivity troponin I in combination with the RCRI for patients undergoing major elective vascular surgery in which the AUC was 0.909 [20]. RCRI: Revised Cardiac Risk Index; NSQIP: National Surgical Quality Improvement Program

Conclusions

Disclosures