Perioperative risk

RCRI Calculator

Calculate the Revised Cardiac Risk Index from six preoperative factors, with a transparent score breakdown and clearly labeled 30-day risk estimates.

Select risk factors

High-risk surgeryIntraperitoneal, intrathoracic, or suprainguinal vascular surgery (original RCRI definition).History of ischemic heart diseasePrior MI, positive ischemia test, ischemic chest pain, nitrate treatment, or pathological Q waves; assess the original criteria clinically.History of heart failureClinical history of heart failure, such as pulmonary edema, paroxysmal nocturnal dyspnea, or documented congestion.History of stroke or TIAPreoperative insulin treatment for diabetesPreoperative creatinine >2.0 mg/dLStrictly greater than 2.0 mg/dL (176.8 µmol/L), using the original RCRI threshold.

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Calculated result

—points

Complete every required field to calculate a result.

RCRI = high-risk surgery + ischemic heart disease + heart failure + cerebrovascular disease + insulin treatment + creatinine >2.0 mg/dL. Each present factor adds 1 point.

Educational use only. This tool and its outputs do not constitute medical advice, diagnosis, or treatment and do not replace clinical judgment. Independently verify the inputs, equations, assumptions, units, and outputs, and confirm that the tool is appropriate for your intended use before relying on a result.

What is RCRI?

The RCRI is a six-factor cardiac risk score developed by Lee and colleagues for major noncardiac surgery. It supports a broader preoperative assessment; it does not provide surgical clearance.

How is it calculated?

RCRI = high-risk surgery + ischemic heart disease + heart failure + cerebrovascular disease + insulin treatment + creatinine >2.0 mg/dL. Each present factor adds 1 point.

Clinical interpretation

Scores range from 0 to 6. This tool displays pooled 30-day myocardial infarction, cardiac arrest, or death estimates summarized in the 2017 Canadian Cardiovascular Society guideline: 0 points, 3.9%; 1 point, 6.0%; 2 points, 10.1%; and 3 or more points, 15.0%. These are not the original 1999 event rates, which used a different composite outcome and study population.

Clinical considerations

The original study enrolled adults aged 50 or older undergoing elective major noncardiac surgery. Performance and calibration differ across procedures and patient groups; use outside that setting requires caution.

The original creatinine criterion is strictly greater than 2.0 mg/dL. The high-risk surgery category uses the RCRI definition, rather than a general impression of surgical complexity.

A low score does not exclude important disease. Active cardiac symptoms, unstable conditions, valve disease, functional capacity, urgency, and procedure-specific factors require separate assessment.

Common questions

What does an RCRI score of 0 mean?

None of the six predictors was selected. It does not mean zero perioperative risk. The displayed percentage comes from pooled studies summarized by CCS in 2017.

Can this calculator replace clinical judgment?

No. This calculator is an educational tool. Its output does not constitute medical advice and does not replace clinical judgment.

References

These calculators are educational tools. Their outputs do not constitute medical advice and do not replace clinical judgment.