Lee Index (RCRI) Score for Gluteal Hemangioma Excision
For a healthy adult without cardiac disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, or renal dysfunction undergoing gluteal hemangioma excision, the Lee (Revised Cardiac Risk Index) score is 0 points, predicting a major cardiac complication risk of 0.4–0.5%.
Understanding the Lee Index Calculation
The Lee index assigns 1 point for each of six independent predictors of major perioperative cardiac events 1:
- History of ischemic heart disease
- History of congestive heart failure
- History of cerebrovascular disease
- Insulin-dependent diabetes mellitus
- Preoperative serum creatinine >2.0 mg/dL (>177 μmol/L)
- High-risk type of surgery
Your patient scores 0 points because none of these risk factors are present 1.
Surgical Risk Classification
Gluteal hemangioma excision is not classified as high-risk surgery under the Lee index 1. High-risk procedures are specifically defined as:
- Intraperitoneal surgery
- Intrathoracic surgery
- Suprainguinal vascular procedures
All other non-laparoscopic procedures—including superficial soft tissue excisions like gluteal hemangioma removal—fall into the lower-risk category 1.
Predicted Cardiac Risk by RCRI Score
Based on the original Lee validation data and European Society of Cardiology guidelines 1, 2:
| RCRI Score | Major Cardiac Complication Rate |
|---|---|
| 0 points | 0.4–0.5% |
| 1 point | 0.9–1.3% |
| 2 points | 4–7% |
| ≥3 points | 9–11% |
With an RCRI of 0, this patient has a <1% risk of major adverse cardiac events (MACE) and is classified as low-risk 3, 4.
Clinical Management Recommendations
Preoperative Testing
No additional cardiac testing is required 3, 4. Patients with RCRI 0–1 can proceed directly to surgery without stress testing, echocardiography, or coronary angiography 3, 4.
A 12-lead ECG is not mandatory but may be reasonable (Class IIb) in asymptomatic patients, though it is not expected to change management for this low-risk scenario 4.
Perioperative Medication Management
- Continue chronic beta-blockers if the patient is already taking them (Class I recommendation) 5, 4
- Continue statins if already prescribed 5
- ACE inhibitors/ARBs can reasonably be continued perioperatively 3
- Do not initiate new beta-blockers for this low-risk patient 3
Monitoring Strategy
Standard intraoperative monitoring is sufficient 5. Intensive hemodynamic monitoring and routine postoperative cardiac biomarker measurement are not indicated for RCRI 0 patients 5.
Important Caveats
Index Limitations
The Lee index has moderate discriminative ability (C-statistic 0.75 for mixed noncardiac surgery) but performs less well in vascular surgery populations 6. For this superficial soft tissue procedure, the index is appropriately applied 1.
The original Lee classification of surgery as simply "high-risk" versus "not high-risk" is somewhat crude; more detailed surgical classification (such as the Erasmus model) can improve risk prediction, but this refinement does not change the low-risk categorization of gluteal hemangioma excision 1, 7.
Emergency Surgery Exception
If this were an emergency procedure, cardiac risk would increase regardless of RCRI score, and the focus would shift to immediate perioperative optimization rather than extensive preoperative testing 4.
Age Consideration
Although not part of the RCRI, age >70 years independently increases perioperative risk 8. The NSQIP calculator incorporates age and may provide superior risk discrimination (C-statistic improvement of 0.11 over RCRI alone) 1, 4.