Patterns of Surgical Risk Assessment at a Tertiary Academic Medical Center

**Objective**: 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. **Methods**: Retrospective chart review of 200 randomly selected patients representing approximately 40% of all patients seen by the hospital medicine consult service from 2019-2020. **Results**: 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. **Conclusion**: Significant heterogeneity exists within preoperative risk stratification practices in this single-center study. Follow-up work remains to promote standardization in approach and documentation.