Retrospective observational study on the effects of altering components of RCRI to improve the predictive capacity.

The current Lee's Revised cardiac risk index (RCRI) was created in 1999. Validation studies have found RCRI to be only moderately discriminant. The "Diabetes Mellitus on insulin" component of the score does not accurately reflect the severity of the disease. A previously studied HbA1C:Hemoglobin ratio shows an improved association with outcomes than individual components alone and could be potentially used as a new marker for severity of the disease.

A retrospective cohort study was performed in consecutive diabetic patients undergoing non-cardiac surgery. Ethics approval was obtained. The objective of the study is to compare the predictive value of RCRI and substitution of the "DM on insulin" component with HH ratio for 30- and 90-day mortality, and postoperative acute myocardial injury(AMI) and acute kidney injury(AKI).

• Above 18 years old
• Past medical history of Diabetes Mellitus or preoperative HbA1C > 6.5% (within 3 months of surgery)
• Had HbA1C done within 3 months prior to date of surgery
• Undergoing non cardiac surgery
• Emergency and elective surgery

EXCLUSION:

• If patient is below 18 years old
• no History of DM
• No HbA1C done within 3 months prior to date of surgery

All patients undergoing non cardiac surgery in Singapore General Hospital

Due to patient identifiers present in the dataset. Sensitive dataset