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

Eric Boersma, M. 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

Research output: Contribution to journalArticle

244 Citations (Scopus)

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 languageEnglish
Pages (from-to)1134-1141
Number of pages8
JournalThe American Journal of Medicine
Volume118
Issue number10
DOIs
Publication statusPublished - Oct 2005

Fingerprint

Mortality
Databases
Cerebrovascular Disorders
Netherlands
Renal Insufficiency
Myocardial Ischemia
Diabetes Mellitus
Heart Failure
Odds Ratio
Confidence Intervals

Keywords

  • Cardiovascular
  • Database
  • Prediction
  • Risk
  • Surgery

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Perioperative cardiovascular mortality in noncardiac surgery : Validation of the Lee cardiac risk index. / Boersma, Eric; Kertai, M.; Schouten, Olaf; Bax, Jeroen J.; Noordzij, Peter; Steyerberg, Ewout W.; Schinkel, Arend F L; Van Santen, Marian; Simoons, Maarten L.; Thomson, Ian R.; Klein, Jan; Van Urk, Hero; Poldermans, Don.

In: The American Journal of Medicine, Vol. 118, No. 10, 10.2005, p. 1134-1141.

Research output: Contribution to journalArticle

Boersma, E, Kertai, M, 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
Boersma, Eric ; Kertai, M. ; Schouten, Olaf ; Bax, Jeroen J. ; Noordzij, Peter ; Steyerberg, Ewout W. ; Schinkel, Arend F L ; Van Santen, Marian ; Simoons, Maarten L. ; Thomson, Ian R. ; Klein, Jan ; Van Urk, Hero ; Poldermans, Don. / Perioperative cardiovascular mortality in noncardiac surgery : Validation of the Lee cardiac risk index. In: The American Journal of Medicine. 2005 ; Vol. 118, No. 10. pp. 1134-1141.
@article{1a94a8b64aa74dd9af3a60d0b44213d4,
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 = "Cardiovascular, Database, Prediction, Risk, Surgery",
author = "Eric Boersma and M. Kertai 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 = "10",
doi = "10.1016/j.amjmed.2005.01.064",
language = "English",
volume = "118",
pages = "1134--1141",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "10",

}

TY - JOUR

T1 - Perioperative cardiovascular mortality in noncardiac surgery

T2 - Validation of the Lee cardiac risk index

AU - Boersma, Eric

AU - Kertai, M.

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 - Cardiovascular

KW - Database

KW - Prediction

KW - Risk

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=25444531495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25444531495&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2005.01.064

DO - 10.1016/j.amjmed.2005.01.064

M3 - Article

C2 - 16194645

AN - SCOPUS:25444531495

VL - 118

SP - 1134

EP - 1141

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 10

ER -