The Revised Cardiac Risk Index (RCRI; NEJM JW Gen Med Oct 1 1999 and Circulation 1999; 100:1043) predicts postoperative adverse cardiac events after noncardiac surgery; however, its applicability to patients undergoing high-risk spinal surgeries has not been demonstrated. Investigators used data from the National Surgical Quality Improvement Program (from 2006–2014) to compare RCRI scores and outcomes — 30-day mortality and adverse cardiac events — among 52,000 patients who underwent posterior lumbar decompression (PLD).
Most patients (98%) had RCRIs of 0 or 1. Thirty-day risk for myocardial infarction (MI), cardiac arrest, or death was 0.1% among patients with RCRIs of 0, ≈0.3% among those with RCRIs of 1, and 0.5% to 0.8% among those with RCRIs of 2. Only 72 patients had RCRIs of 3 or 4; 2 of these patients suffered MIs, and 1 died. Even after adjusting for comorbidities, escalating RCRI risk independently predicted higher risk for cardiac complications.
These patients who were undergoing PLD surgery had somewhat lower risk for adverse cardiovascular events or death than did the noncardiac-surgery population assessed in the original RCRI prediction model; nevertheless, risk increases with higher RCRI scores. This information can facilitate shared decision making during preoperative evaluations.