Patients Undergoing Major Cancer Surgery: Incidence and Predictive Value for Postoperative Cardiac Events

Inclusion Criteria: * Age 50 or older * Undergoing High Risk Cancer Surgery (Patient must be undergoing one of the following procedures NOTE: All open or robotic forms of the following procedures meet the eligibility criteria. GMT/ Hepatobiliary * Pancreatic Resection * Retroperitoneal Sarcomas * Shoulder (Forequarter) Amputation * Esophagectomy, Esophagogastrectomy * Pheochromocytoma * Liver Resection (with or without Bile Duct Resection) Orthopedics * Spine Resections (with or without Spinal Fusion) * Metastatic Disease Requiring Total Hip Replacement * Total Shoulder Replacement / Forequarter Amputation * Hemipelvectomy * Sacrectomy Thoracic * Extrapleural Pneumonectomy * Pleurectomy and Decortication * Pneumonectomy * Esophagogastrectomy * Mediastinal Tumor Resection * Pancoast Tumor * Completion Pneumonectomy * Lobectomy (post-induction chemotherapy; or severe COPD) * Segmentectomy Colorectal/ GYN * Colon Resection with possible Sacrectomy * Pelvic Exenteration * Advanced ovarian cancer resection with or without liver resection Urology * Radical Cystectomy * Open Radical Prostatectomy * Nephrectomy with Vena Caval Resection Head \& Neck * Thyroid Resection with Mediastinal involvement * Major head and neck cancer resection with Free Flap reconstruction Other * Unclassified Major Surgery at the Discretion of the PI * Postoperative stay likely to be 2 or more days * Patients willing to tolerate inflation of a blood pressure cuff for 5 minutes * Patients willing to cut long nails in order to wear finger probe. * Patients with one or more of the following RCRI risk factors: * History of ischemic heart disease (any) * History of myocardial infarction * History of positive exercise test * Current complaint of chest pain considered secondary to myocardial ischemia * Use of nitrate therapy * ECG with pathological Q waves * History of congestive heart failure (any) * History of congestive heart failure * Pulmonary edema * Paroxysmal nocturnal dyspnea * Bilateral rales or S3 gallop * Chest radiograph showing pulmonary vascular redistribution * History of cerebrovascular disease (any) * History of transient ischemic attack (TIA) or stroke * Preoperative treatment with insulin * Preoperative serum creatinine \> 2.0 mg/dL * Evidence of peripheral vascular disease other than cerebral vascular disease (Although peripheral vascular disease is not strictly a RCRI risk factor, Fleisher indicates: "It would not be inappropriate to assume that any atherosclerotic class of disease is equivalent to ischemic heart disease for risk purposes." Exclusion Criteria: * Medical conditions precluding use of arm blood pressure measurements such as prior lymphadenectomy, vascular shunts for dialysis or upper extremity occlusive vascular disease * Patients undergoing emergency surgery * Any of the following active conditions * Unstable coronary syndromes * Uncompensated heart failure; worsening or new onset CHF * Significant arrhythmias * Atrial fibrillation, presently * High grade AV block * Symptomatic ventricular arrhythmias or new ventricular arrhythmias * Supraventricular arrhythmias with poor rate control * Symptomatic bradycardia * Severe valvular disease * Severe aortic stenosis (mean transvalvular gradient \>40mmHg) * Symptomatic mitral stenosis * Any other condition that at the judgment of the investigator might require additional evaluation and treatment before surgery.