Key result
An RCRI Class IV was associated with a more than two-fold increased risk of 1-year postoperative mortality compared to RCRI Class I (adjusted HR 2.14; 95% CI 1.78-2.56; p<0.001).
Why the study?
The study was conducted to explore risk factors for 1-year postoperative mortality and identify its association with the Revised Cardiac Risk Index.
Does a higher Revised Cardiac Risk Index (RCRI) predict increased 1-year postoperative mortality in adult surgical patients?
Cohort (n=54,933)
No
Does a higher Revised Cardiac Risk Index (RCRI) predict increased 1-year postoperative mortality in adult surgical patients?
Hazard Ratio: 2.14 (95% CI 1.78–2.56)
p-value: p=< 0.001
The Revised Cardiac Risk Index (RCRI) is significantly associated with 1-year postoperative mortality, with Class IV patients having more than double the risk compared to Class I.
Supports RCRI for preoperative risk stratification; leaves open whether RCRI-guided interventions improve 1-year survival.
OBJECTIVE: To explore risk factors for 1-year postoperative mortality and to identify its association with the Revised Cardiac Risk Index (RCRI). METHODS: This was a retrospective cohort study involving 54,933 patients aged 18 years and above who were surgically treated under general or regional anesthesia in a tertiary hospital in Singapore. Independent risk factors for 1-year postoperative mortality were identified by univariate Cox regression analysis. The association between the RCRI and 1-year postoperative mortality was assessed by the Kaplan-Meier estimator and multivariate Cox regression analysis and was further validated in subgroup analyses stratified by the sex, age, and type of anesthesia. RESULTS: A total of 54,933 eligible patients were enrolled in this study that included 23,922 patients classified as RCRI Class I, 25,979 as Class II, 3700 as Class III, and 1332 as Class IV. Cox regression analysis demonstrated that male sex, age, higher American Society of Anesthesiologists (ASA) physical status classification level, regional anesthesia, emergency surgery, degree of anemia, and increased RCRI were significantly associated with the increased risk of 1-year postoperative mortality (HR > 1, all P < 0.001). The significant association between RCRI and 1-year postoperative mortality still existed after adjusting for confounding factors. An RCRI Class IV was associated with a mortality risk greater than two-fold larger than that observed at an RCRI Class I (adjusted HR 2.14, 95 % CI 1.78 to 2.56, p < 0.001). Subgroup analyses revealed that the 1-year postoperative mortality was significantly higher in patients with RCRI Class IV than that of Classes I-III regardless of the sex, age, and type of anesthesia. CONCLUSION: RCRI is significantly correlated with 1-year postoperative mortality regardless of sex, age, and type of anesthesia. Further studies to validate these findings are warranted.
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Hao et al. (2025) conducted a cohort in Surgical patients under general or regional anesthesia (n=54,933). Revised Cardiac Risk Index (RCRI) Class IV vs. RCRI Class I was evaluated on 1-year postoperative mortality (adjusted HR 2.14, 95% CI 1.78 to 2.56, p=< 0.001). An RCRI Class IV was associated with a more than two-fold increased risk of 1-year postoperative mortality compared to RCRI Class I (adjusted HR 2.14; 95% CI 1.78-2.56; p<0.001).
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