Physician estimates of perioperative cardiac risk in patients undergoing noncardiac surgery: Rhyme or reason?

We know little about how physicians assess perioperative risk and how accurate their assessments are. The purpose of this study was to determine the extent to which clinicians explicitly record the use of validated cardiac risk indices (e.g., the Detsky and Goldman indices) in preoperative evaluations, and to determine if recorded clinical assessments of low, moderate and high risk correspond to assessments using validated cardiac indices. We evaluated 163 preoperative consultations for 150 patients who met the following criteria: 40 years of age or older; surgery conducted, or postponed/cancelled because of cardiac concerns. Charts of all patients were reviewed for explicit use of a cardiac risk index and statements of perioperative cardiac risk.