Revised Cardiac Risk Index versus ASA Status as a Predictor for Noncardiac Events After Posterior Lumbar Decompression Rachel S. Bronheim 1 , Eric K. Oermann 2 , David S. Bronheim 3 , John M. Caridi 2,4 - BACKGROUND: The Revised Cardiac Risk Index (RCRI) was designed to predict risk for cardiac events after noncardiac surgery. However, there is a paucity of litera- ture that directly addresses the relationship between RCRI and noncardiac outcomes after posterior lumbar decom- pression (PLD). The objective of this study is to determine the ability of RCRI to predict noncardiac adverse events after PLD. - METHODS: The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing PLD from 2006 to 2014. Multivariate and receiver operating characteristic analysis was used to identify associations between RCRI and postoperative complications. - RESULTS: A total of 52,066 patients met the inclusion criteria. Membership in the RCRI[1 cohort independently predicted unplanned intubation, ventilation >48 hours, progressive renal insufficiency, acute renal failure, urinary tract infection (UTI), sepsis, septic shock, and readmission. Membership in the RCRI[2 cohort independently predicted for superficial surgical site infection, pneumonia, un- planned intubation, ventilation >48 hours, bleeding trans- fusion, progressive renal insufficiency, acute renal failure, UTI, sepsis, septic shock, and readmission. Membership in the RCRI[3 cohort independently predicted unplanned intubation (odds ratio [OR], 11.8), ventilation >48 hours (OR, 23.0), acute renal failure (OR, 84.5), and UTI (OR, 3.6). RCRI had a poor discriminative ability (DA) (area under the curve [ 0.623), and American Society of Anesthesiologists status had a fair DA (area under the curve [ 0.770) to predict a composite of noncardiac complications. - CONCLUSIONS: RCRI was predictive of a wide range of noncardiac complications after PLD but had a diminished DA to predict a composite of any noncardiac complication than did American Society of Anesthesiologists score. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality after lumbar decompression. INTRODUCTION P osterior lumbar decompression (PLD) is one of the most common spinal procedures and is used to treat a variety of spinal conditions by relieving pressure on the spinal cord or nerve roots. 1 Although the literature shows that PLD helps improve quality of life, pain, and disability scores, it remains associated with significant postoperative morbidity. 1,2 Complica- tions of the procedure include wound infections, epidural hema- toma, dural tears, neurologic deterioration, prolonged length of stay, and discharge to a location other than home. 1,3,4 As cases of patients undergoing spine surgery have become more complex, Key words - Noncardiac complications - NSQIP posterior lumbar decompression - Outcome - Revised Cardiac Risk Index Abbreviations and Acronyms ACS-NSQIP: American College of Surgeons National Surgical Quality Improvement Program ASA: American Society of Anesthesiologists AUC: Area under the curve CHF: Congestive heart failure CVA: Cerebrovascular accident DA: Discriminative ability MI: Myocardial infarction OR: Odds ratio PE: Pulmonary embolism PLD: Posterior lumbar decompression RCRI: Revised Cardiac Risk Index ROC: Receiver operating characteristic SSI: Surgical site infection UTI: Urinary tract infection From the Departments of 1 Medical Education, 2 Neurosurgery, 3 Anesthesiology, and 4 Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA To whom correspondence should be addressed: John M. Caridi, M.D. [E-mail: john.caridi@mountsinai.org] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.09.028 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e10, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article