The Importance of the Lee Score in Perioperative Medicine

In medical practice, patient safety is the highest priority, especially in perioperative contexts where the risk of complications can be elevated. In this scenario, the Lee score, formally known as the Revised Cardiac Risk Index (RCRI), emerges as a fundamental tool.

The Lee score is used to assess the risk of major cardiac events, such as myocardial infarction and cardiac death, in patients undergoing non-cardiac surgery. Developed based on retrospective studies and validated in various clinical contexts, this index incorporates six simple preoperative criteria, including history of ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus treated with insulin, chronic kidney disease, and high-risk surgery. The resulting score classifies patients into risk categories, guiding physicians in implementing strategies for risk mitigation, such as administering specific therapies and choosing the type of anesthesia, significantly contributing to the reduction of perioperative morbidity and mortality.

Check out in this article the importance of the Lee score in perioperative medicine, highlighting its functionality, application, and impact on clinical decision-making.

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What is the Lee Score?

Developed by Thomas H. Lee et al. in the late 1990s, the Lee score is a scoring system that assesses the risk of major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery. The score is based on six pre-operative criteria: history of coronary artery disease, heart failure, cerebrovascular disease, diabetes mellitus treated with insulin, chronic kidney disease, and high-risk surgery.

The aim of the Lee score is to provide physicians with a quantitative tool to assess a patient's cardiovascular risk before surgery, allowing for better preparation and management of potential complications. The final score is calculated based on the presence of these risk factors, each contributing a specific weight to the total score. Depending on the score achieved, patients are classified into different risk levels, ranging from low to high.

This scoring system has proven to be a valuable resource in medical practice, guiding decision-making regarding the need for preventive interventions, such as specific medications or procedures, before surgical procedures. For instance, a patient with a high score may benefit from therapies to stabilize heart disease before undergoing surgery, while a patient with a low score may not require additional measures beyond standard care.

Furthermore, the Lee score has been continually revised and updated in light of new evidence and technologies, ensuring it remains relevant and accurate. Its application is not limited to pre-operative assessment but also serves as an important tool for discussion among the surgical team, anesthesiologist, and cardiologist, promoting a multidisciplinary approach to patient safety. The inclusion of these criteria in electronic health record systems has facilitated their adoption and routine use, integrating risk assessments into the clinical decision-making process.

Functionality and Application

The main functionality of the Lee score is to stratify the risk of cardiac complications in the perioperative period, allowing healthcare professionals to identify high-risk patients and implement mitigation strategies. The practical application of the Lee score involves collecting clinical data from the patient and analyzing this data to calculate a total score, which is directly correlated with the risk of cardiac complications.

Additionally, the utility of the Lee score extends beyond simple risk stratification. It also plays a crucial role in pre-operative planning, influencing the selection of procedures and determining the need for prior cardiac interventions. This can range from adjustments in medication to the performance of invasive procedures, such as angioplasty, with the goal of minimizing the risk of cardiac complications during and after surgery.

Furthermore, the Lee score is often used in interdisciplinary discussions among surgeons, anesthesiologists, and cardiologists to align expectations and plan patient management more effectively. Including the score in the informed consent process provides patients with a clear understanding of the risks involved, facilitating shared decision-making.

In terms of research, the Lee score has been the subject of numerous studies seeking to validate its effectiveness and accuracy in predicting adverse cardiac events. These studies have helped to refine the score over time, adding or modifying criteria based on new scientific evidence. With the advancement of technology and the growing availability of large clinical databases, the Lee score is expected to continue evolving, becoming even more precise and useful in clinical practice.

Lastly, the application of the Lee score is not limited to the hospital setting. With the digitalization of health, online tools and mobile apps have begun to incorporate the Lee score, allowing physicians and patients to perform risk assessments conveniently and quickly. This accessibility enhances the potential for preventive interventions and the personalization of care, underscoring the importance of the Lee score as a valuable tool in modern medicine.

Integrating the Lee Score into Ninsaúde Clinic Forms for Enhancement of Perioperative Assessment

The use of digital tools in healthcare has transformed medical practice, providing greater efficiency, accuracy, and quality in patient care. Ninsaúde Clinic, with its customizable form models, offers a robust platform for the integration of clinical assessment tools such as the Lee score. Here's how healthcare professionals can utilize the Lee score through Ninsaúde Clinic's forms to optimize perioperative assessment.

Step by Step for Implementing the Lee Score in Ninsaúde Clinic

• Creating the Custom Form: The first step is to create a custom form in Ninsaúde Clinic specifically for perioperative assessment. This can be done by accessing the system's app section and selecting the form templates option.
• Including the Lee Score Criteria: The form should include fields for each of the six criteria used in the Lee score: history of coronary artery disease, heart failure, cerebrovascular disease, diabetes mellitus treated with insulin, chronic kidney disease, and high-risk surgery. It's important that each field allows recording the presence or absence of these criteria in the patient. For this, professionals can use the multiple-choice response option.
• Automated Score Calculation: To add value to the form, an automated calculation functionality that sums the points based on the provided answers can be implemented. To do this, when creating the form, simply include the value of each answer when entering them as multiple choices, as the system has a specific field for this. After that, to perform the score summation, a topic using the calculated field option should be created, where the formula that will perform the calculation based on the responses will be applied.
• Interpretation and Actions Based on the Score: The form should include a section for the interpretation of the calculated score, offering guidelines on the recommended actions based on the identified risk. This can range from proceeding with the planned procedure with standard monitoring to the need for additional cardiac assessments or risk mitigation measures.
• Integration with the Electronic Health Record: The form model is easily accessible and integrable into the patient's electronic health record within Ninsaúde Clinic. This allows healthcare professionals quick access to perioperative assessment information during all phases of patient care. The model can be used during care or when accessing the patient's file, in the history tab. Thus, healthcare professionals can use this functionality both during and before or after care.

Benefits of Integrating the Lee Score into Ninsaúde Clinic

• Enhancement of Risk Assessment: Implementing the Lee score in Ninsaúde Clinic's forms allows for an accurate perioperative cardiac risk assessment, contributing to informed clinical decision-making.
• Operational Efficiency: The automation of score calculation and integration with the electronic health record save time and improve operational efficiency, allowing healthcare professionals to focus on patient care.
• Improvement of Patient Safety: Accurate identification of patients at risk of cardiac complications can lead to the implementation of preventive strategies, significantly improving patient safety and outcomes.

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