“The revised cardiac risk index score1 is 0, so the patient can go to the operating room, right?” While patient histories and physical examinations have continued value in most other fields of medicine, perioperative risk assessment may sometimes be condensed to such a singular thought process. But are risk calculators enough by themselves?
The field of perioperative medicine has seen the development of multiple risk calculators for cardiac risk assessment (Box).1-6 These calculators have been valuable in identifying the risk factors for major cardiovascular outcomes. They are easy to use by surgeons or advanced practice clinicians, anesthesiologists, and internists. Patients who are deemed to be at low or very high risk based on these calculators may not need stress testing, leading to a judicious use of resources. Some calculators, such as the American College of Surgeons’ National Surgical Quality Improvement Program universal surgical risk calculator (ACS NSQIP), calculate the risk of multiple complications beyond just cardiac.2 These calculators may help engage patients in shared decision-making before undergoing surgery, especially the high-risk patients who may otherwise underestimate their risk. These decision aids may help motivate patients toward risk-reduction strategies before undergoing surgery.
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Rohatgi N. Perioperative Risk Calculators and the Art of Medicine. JAMA Intern Med. 2019;179(12):1619–1620. doi:10.1001/jamainternmed.2019.4914
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