Annals of internal medicine
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Review Meta Analysis
Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index.
The Revised Cardiac Risk Index (RCRI) is widely used to predict perioperative cardiac complications. ⋯ The RCRI discriminated moderately well between patients at low versus high risk for cardiac events after mixed noncardiac surgery. It did not perform well at predicting cardiac events after vascular noncardiac surgery or at predicting death. High-quality research is needed in this area of perioperative medicine.
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Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. ⋯ Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.
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The United States spends more on health care than other nations, yet our health outcomes remain inferior to those of many countries. Change is therefore necessary. One approach to health care reform is to identify and eliminate practices associated with high cost and limited benefit. ⋯ Thus, many "accepted" perioperative practices conflict with the evidence and can be safely discontinued while preserving outcomes and reducing costs. Implementation of the American College of Cardiology/American Heart Association perioperative guidelines ensures cost-effective management and promises the greatest benefit for our patients. Our society demands better care at lower cost; in perioperative medicine, it is time for us to throttle back.
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Editorial Comment
Spending more to save more: interventions to promote adherence.