Goldman index

Goldman Index is a clinical tool used to assess the risk of cardiac complications in patients undergoing non-cardiac surgery. It was introduced by Lee Goldman and colleagues in 1977, aiming to improve the preoperative evaluation of patients by identifying those at higher risk of cardiac events. The Goldman Index, also known as the Goldman Cardiac Risk Index, incorporates a variety of clinical factors and has been a cornerstone in preoperative assessment for decades, although it has been superseded by more recent risk stratification tools.

Development and Components

The Goldman Index was developed through a study that analyzed various preoperative variables to predict postoperative cardiac complications. The index assigns points based on the presence of specific risk factors, with a higher total score indicating a greater risk of complications. The key components of the Goldman Index include:

• History of significant myocardial infarction
• History of congestive heart failure
• History of cerebrovascular accident
• Diabetes mellitus requiring insulin therapy
• Renal insufficiency
• High-risk surgery
• Age over 70 years

Each of these factors is assigned a different weight, reflecting its relative importance in predicting cardiac risk.

Application

The primary application of the Goldman Index is in the preoperative setting, where it helps clinicians identify patients at higher risk of cardiac complications following non-cardiac surgery. This risk stratification enables tailored perioperative management strategies, potentially reducing the incidence of adverse cardiac events.

Limitations and Updates

While the Goldman Index was pioneering at its inception, it has limitations. Its applicability to contemporary patient populations and modern surgical and anesthetic practices has been questioned. Advances in perioperative care, along with the development of new diagnostic tools and treatments for cardiac conditions, have led to the creation of newer risk assessment models. The Revised Cardiac Risk Index (RCRI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator are examples of tools that have been developed to provide more accurate risk assessments in the current era.

Conclusion

The Goldman Index represents a significant milestone in the evolution of perioperative cardiac risk assessment. Despite being less commonly used today, its development marked a shift towards a more systematic approach to preoperative evaluation, laying the groundwork for subsequent advances in the field.