End
RCRI (Lee Index)
Estimates risk of major cardiac complications after non-cardiac surgery.
High-risk surgery
Intraperitoneal, intrathoracic, or suprainguinal vascular
Ischemic heart disease
History of MI, positive stress test, ischemia-related chest pain, or Q waves
Congestive heart failure
History of pulmonary edema, PND, S3 gallop, or vascular redistribution on CXR
Cerebrovascular disease
Prior history of stroke or TIA
Pre-op Insulin Use
Current treatment with insulin for diabetes
Creatinine > 2.0 mg/dL
Pre-operative serum creatinine > 176.8 µmol/L
0
Points
Low Risk
No elevated risk factors.
Estimated Risk: 0.5%
| Points | Risk Group | Approx. Event Risk |
|---|---|---|
| 0 | Class I (Low) | 0.5% |
| 1 | Class II (Elevated) | 1.1% |
| 2 | Class III (Elevated) | 5% |
| ≥ 3 | Class IV (Elevated) | 10% |
1
Elevated Risk Protocol: If RCRI ≥ 1, patient age ≥ 65, or 45-64 with significant cardiac disease, consider obtaining NT-proBNP or BNP.
2
Post-op Monitoring: If NT-proBNP ≥ 300 ng/L or BNP ≥ 92 ng/L, order an EKG in the PACU and measure troponins daily for 48-72 hours.
3
Limitations: RCRI may underestimate hemodynamic complications in patients with valvular disease. It does not assess risk of stroke or bleeding.
