Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index

Eric Boersma; Miklos D Kertai; Olaf Schouten; Jeroen J Bax; Peter Noordzij; Ewout W Steyerberg; Arend F L Schinkel; Marian van Santen; Maarten L Simoons; Ian R Thomson; Jan Klein; Hero van Urk; Don Poldermans

doi:10.1016/j.amjmed.2005.01.064

Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index

Eric Boersma^*
, Miklos D Kertai
, Olaf Schouten
, Jeroen J Bax
, Peter Noordzij
, Ewout W Steyerberg
, Arend F L Schinkel
, Marian van Santen
, Maarten L Simoons
, Ian R Thomson
, Jan Klein
, Hero van Urk
, Don Poldermans

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution.

METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death.

RESULTS: A total of 1877 patients (1.7%) died perioperatively, including 543 (0.5%) classified as cardiovascular death. The cardiovascular death rates were 0.3% (255/75 352) for Lee Class 1, 0.7% (196/28 892) for Class 2, 1.7% (57/3380) for Class 3, and 3.6% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85.

CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.

Original language	English
Pages (from-to)	1134-1141
Number of pages	8
Journal	The American Journal of Medicine
Volume	118
Issue number	10
DOIs	https://doi.org/10.1016/j.amjmed.2005.01.064
Publication status	Published - Oct 2005
Externally published	Yes

Keywords

Adult
Aged
Cardiovascular Diseases/mortality
Databases as Topic
Emergencies
Female
Humans
Infections/mortality
Male
Middle Aged
Netherlands/epidemiology
Perioperative Care/mortality
Postoperative Complications/mortality
Retrospective Studies
Risk Assessment
Sex Distribution
Surgical Procedures, Operative/statistics & numerical data

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10.1016/j.amjmed.2005.01.064

Cite this

Boersma, E., Kertai, M. D., Schouten, O., Bax, J. J., Noordzij, P., Steyerberg, E. W., Schinkel, A. F. L., van Santen, M., Simoons, M. L., Thomson, I. R., Klein, J., van Urk, H., & Poldermans, D. (2005). Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. The American Journal of Medicine, 118(10), 1134-1141. https://doi.org/10.1016/j.amjmed.2005.01.064

@article{1a240c07d0d442cb99b1590a31484910,

title = "Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index",

abstract = "PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution.METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death.RESULTS: A total of 1877 patients (1.7\%) died perioperatively, including 543 (0.5\%) classified as cardiovascular death. The cardiovascular death rates were 0.3\% (255/75 352) for Lee Class 1, 0.7\% (196/28 892) for Class 2, 1.7\% (57/3380) for Class 3, and 3.6\% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95\% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85.CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.",

keywords = "Adult, Aged, Cardiovascular Diseases/mortality, Databases as Topic, Emergencies, Female, Humans, Infections/mortality, Male, Middle Aged, Netherlands/epidemiology, Perioperative Care/mortality, Postoperative Complications/mortality, Retrospective Studies, Risk Assessment, Sex Distribution, Surgical Procedures, Operative/statistics \& numerical data",

author = "Eric Boersma and Kertai, \{Miklos D\} and Olaf Schouten and Bax, \{Jeroen J\} and Peter Noordzij and Steyerberg, \{Ewout W\} and Schinkel, \{Arend F L\} and \{van Santen\}, Marian and Simoons, \{Maarten L\} and Thomson, \{Ian R\} and Jan Klein and \{van Urk\}, Hero and Don Poldermans",

year = "2005",

month = oct,

doi = "10.1016/j.amjmed.2005.01.064",

language = "English",

volume = "118",

pages = "1134--1141",

journal = "The American Journal of Medicine",

issn = "0002-9343",

publisher = "Elsevier",

number = "10",

}

Boersma, E, Kertai, MD, Schouten, O, Bax, JJ, Noordzij, P , Steyerberg, EW, Schinkel, AFL, van Santen, M, Simoons, ML, Thomson, IR, Klein, J, van Urk, H & Poldermans, D 2005, 'Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index', The American Journal of Medicine, vol. 118, no. 10, pp. 1134-1141. https://doi.org/10.1016/j.amjmed.2005.01.064

TY - JOUR

T1 - Perioperative cardiovascular mortality in noncardiac surgery

T2 - validation of the Lee cardiac risk index

AU - Boersma, Eric

AU - Kertai, Miklos D

AU - Schouten, Olaf

AU - Bax, Jeroen J

AU - Noordzij, Peter

AU - Steyerberg, Ewout W

AU - Schinkel, Arend F L

AU - van Santen, Marian

AU - Simoons, Maarten L

AU - Thomson, Ian R

AU - Klein, Jan

AU - van Urk, Hero

AU - Poldermans, Don

PY - 2005/10

Y1 - 2005/10

N2 - PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution.METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death.RESULTS: A total of 1877 patients (1.7%) died perioperatively, including 543 (0.5%) classified as cardiovascular death. The cardiovascular death rates were 0.3% (255/75 352) for Lee Class 1, 0.7% (196/28 892) for Class 2, 1.7% (57/3380) for Class 3, and 3.6% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85.CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.

AB - PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution.METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death.RESULTS: A total of 1877 patients (1.7%) died perioperatively, including 543 (0.5%) classified as cardiovascular death. The cardiovascular death rates were 0.3% (255/75 352) for Lee Class 1, 0.7% (196/28 892) for Class 2, 1.7% (57/3380) for Class 3, and 3.6% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85.CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.

KW - Adult

KW - Aged

KW - Cardiovascular Diseases/mortality

KW - Databases as Topic

KW - Emergencies

KW - Female

KW - Humans

KW - Infections/mortality

KW - Male

KW - Middle Aged

KW - Netherlands/epidemiology

KW - Perioperative Care/mortality

KW - Postoperative Complications/mortality

KW - Retrospective Studies

KW - Risk Assessment

KW - Sex Distribution

KW - Surgical Procedures, Operative/statistics & numerical data

U2 - 10.1016/j.amjmed.2005.01.064

DO - 10.1016/j.amjmed.2005.01.064

M3 - Article

C2 - 16194645

SN - 0002-9343

VL - 118

SP - 1134

EP - 1141

JO - The American Journal of Medicine

JF - The American Journal of Medicine

IS - 10

ER -

Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index

Abstract

Keywords

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