Cardiovascular Outcome in View of the Revised Cardiac Risk Index and Geriatric Sensitive Cardiac Risk Index in oldest old Following Spinal Anesthesia

Abstract

<strong>Background: </strong> The RCRI and GSCRI are utilized to assess the risk of MACE following surgery, regardless of anesthesia type, and without specific consideration for the oldest-old patients. Given the prevalence of spinal anesthesia as a preferred technique in geriatric patients, our objective was to assess the applicability of these indices in patients aged 80 and older who underwent surgery under spinal anesthesia. Additionally, we aimed to identify potential risk factors for postoperative major adverse cardiac events. The correlation between both indices and postoperative admission to the intensive care unit and length of hospital stay was explored as a secondary outcome. <br /> <strong>Methods: </strong> We assessed the efficacy of both indices in estimating the risk of in-hospital postoperative MACE through their external validation (discrimination, calibration, and clinical utility) using the appropriate statistical methods. <br /> <strong>Results: </strong> The incidence of MACE was 7.5 %. Both indices displayed limited discriminative ability, with the area under the curve for RCRI and GSCRI being 0.69 and 0.68, respectively. The calibration analysis also indicated their restricted predictive ability. Regression analysis revealed that patients with atrial fibrillation had a 3.77-fold higher likelihood, and those underwent trauma surgery had a 2.03-fold higher likelihood of experiencing MACE. Moreover, the odds of MACE increased by 9% for each additional year above 80. Integration of these factors into both indices (multivariable models) enhanced the discriminative ability (the area under the curve reached 0.798 and 0.777 for RCRI and GSCRI, respectively). Bootstrap analysis demonstrated that the predictive ability improved for the multivariate GSCRI but not for the multivariate RCRI. Decision curve analysis indicated that the multivariate GSCRI had superior clinical utility compared to the multivariate RCRI. Both indices exhibited poor correlation with postoperative intensive care unit admission and length of hospital stay. <br /> <strong>Conclusions </strong> Both indices showed limited predictive ability in estimating in-hospital MACE risk and had weak correlations with postoperative intensive care unit admission and length of hospital stay in the oldest-old patients following surgery under spinal anesthesia. The updated versions, incorporating age, atrial fibrillation, and trauma surgery, enhanced the performance of the GSCRI but not the RCRI.