title: Indication for surgery, the revised cardiac risk index, and 1-year mortality.
abstract: BACKGROUND
  Patients who undergo vascular surgery are at increased risk of perioperative cardiovascular morbidity and mortality. The Revised Cardiac Risk Index (RCRI) is a validated and widely used bedside tool for estimating the risk of a perioperative major adverse myocardial event. We hypothesized that inclusion of the indication for surgery would add independent and prognostic information to the RCRI in predicting all-cause 30-day and 1-year mortality in open infrainguinal vascular surgical procedures.
  
  
  METHODS
  This was a retrospective study of 603 patients who underwent open infrainguinal bypass vascular surgery between January 2002 and January 2008 at a tertiary care medical center. RCRI and indication for surgery were determined. The primary outcomes of interest were all-cause 30-day mortality (which included all in-hospital mortality, regardless of time) and all-cause 1-year mortality.
  
  
  RESULTS
  Overall 30-day mortality was 32 (5.3%). Independent risk factors for early death were RCRI score, being of age ≥80 years, American Society of Anesthesiologists Physical Status classification = 4, and emergency surgery. Overall 1-year mortality, including early deaths, was 114 (18.9%). Indication for surgery, RCRI score, age, American Society of Anesthesiologists Physical Status classification = 4, female sex, and emergency surgery were all independent predictors of 1-year mortality.
  
  
  CONCLUSIONS
  The RCRI score was associated with both 30-day and 1-year mortality in patients undergoing lower extremity bypass surgery. Indication for surgery was predictive of 1-year mortality but not of 30-day mortality.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. vm2161@columbia.edu
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Moitra
authors.forename: Brigid C
authors.initials: BC
authors.lastname: Flynn
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: David
authors.initials: D
authors.lastname: Bronheim
authors.forename: John E
authors.initials: JE
authors.lastname: Ellis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*