Patterns of Surgical Risk Assessment at a Tertiary Academic Medical Center

Review preoperative risk stratification encounters performed by a hospital medicine consult service at a tertiary academic medical center to better characterize practice patterns and evaluate the need to standardize our approach to risk assessment.

Retrospective chart review of 200 randomly selected patients representing approximately 40% of all patients seen by the hospital medicine consult service from 2019-2020.

Of the 200 charts reviewed, there were 71 preoperative risk assessments performed and 8 distinct approaches utilized. The most common risk stratification tool used was the Revised Cardiac Risk Index (RCRI), followed by the American College of Surgeons-Surgical Risk Calculator (ACS-SRC) and then the Gupta Myocardial Infarction and Cardiac Arrest calculator. 19 encounters (27%) used multiple risk stratification tools, while 11 encounters (15%) were not consistent with American College of Cardiology/American Heart Association guidelines.

Significant heterogeneity exists within preoperative risk stratification practices in this single-center study. Follow-up work remains to promote standardization in approach and documentation.