Estimation of cardiac risk before noncardiac surgery: the evolution of cardiac risk indices.
Postoperative cardiac complications are among the most feared events in patients undergoing noncardiac surgery. Hospitalists, internists, cardiologists, and anesthesiologists are frequently asked to provide preoperative consultations to assess risk and optimize medical treatment for the patient. Over the years, numerous studies have attempted to define preoperative risk factors in an attempt to risk stratify patients and determine when interventions may be applied to reduce risk. These studies have proposed various risk indices and algorithms based on identification of different risk factors, related to variations in patient populations, types of surgery, definitions of comorbidities, and endpoints studied. This article reviews many of these risk indices, highlighting their findings, utilities, and limitations.
Medical Director, UHealth Preoperative Assessment Center, University of Miami, Miami, FL; Director, University of Miami Health System Medical Consultation Service, Miami, FL; Professor of Clinical Medicine, Department of Medicine, Division of Hospital Medicine, University of Miami Miller School of Medicine, Miami FL. scohn@med.miami.edu.
Steven L
SL
Cohn
Stalin
S
Subramanian
D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D002985:Clinical Protocols; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012737:Sex Factors