Evidence Based Practice and Quality Assurance
Background and Goal of Study: This study aimed to revise and customize the Revised Cardiac Risk (Lee) index to estimate the probability of perioperative all-cause mortality in patients undergoing noncardiac vascular surgery.
Materials and Methods: We studied 2,310 patients (mean age, 67.8 ± 11.3 years; males 1,747) who underwent acute or elective major noncardiac vascular surgery between 1991-2000 at the Erasmus MC. In a total of 1,535 patients was assigned for model development, in which the association between predictor variables and mortality occurring within 30 days after surgery were identified to revise and customize the Lee-index, which was then evaluated in a validation cohort of 773 patients.
Results and Discussions: The perioperative mortality rates were similar in the development (n = 103, 6.7%) and validation populations (n = 50, 6.1%). The customized risk-prediction model for perioperative mortality identified and allocated scores to type of vascular surgery (acute abdominal aortic aneurysm rupture, +43; thoraco-abdominal and abdominal aortic surgery, +26; infrainguinal bypass, +15; carotid endarterectomy, 0), ischemic heart disease (+13), congestive heart failure (+14), prior stroke (+10), hypertension (+7), renal dysfunction (+16) and chronic pulmonary disease (+7) associated with increased risk, whereas beta-blocker (−15) and statin use (−10) with a lower risk of mortality.
Conclusions: The customized index provides more detailed information than the Lee-index about the type of vascular procedure, clinical risk factors and concomitant medication use.