Key result
Prior heart failure linked to ~11-fold higher CV complication risk after non-cardiac surgery in African patients.
Why the study?
The burden of cardiovascular disease and the risk of postoperative cardiovascular complications in patients requiring non-cardiac surgery in Africa is not known.
Observational (n=3,045)
Yes
Relative Risk: 11.5 (95% CI 5.36–24.64)
p-value: p=<0.0001
There is a substantial burden of cardiovascular disease in African patients presenting for non-cardiac surgery, and the Revised Cardiac Risk Index provides moderate discrimination for major cardiac complications in this population.
May warrant heightened perioperative vigilance in patients with prior heart failure; extends risk data to African surgical cohorts but leaves validation open.
BACKGROUND: The burden of cardiovascular disease in patients requiring non-cardiac surgery in Africa is not known. These patients are at increased risk for postoperative cardiovascular complications. OBJECTIVES: In this sub-study, to use data on comorbidities and surgical outcomes from two large observational studies, the South African Surgical Outcomes Study (SASOS) and the African Surgical Outcomes Study (ASOS), to investigate the prevalence of cardiovascular disease in elective surgical patients and the risk of postoperative cardiovascular complications in this population. METHODS: SASOS and ASOS were both prospective, observational cohort studies that collected data over 1 week in each participating centre. The primary outcome was in-hospital postoperative complications, which included prespecified and defined cardiovascular complications. We defined the cardiovascular disease burden of patients aged ≥45 years presenting for surgery (main objective), determined the relative risk of developing postoperative cardiovascular complications (secondary objective) and assessed the utility of the Revised Cardiac Risk Index (RCRI) for preoperative cardiovascular risk stratification of elective, non-cardiac surgical patients in Africa (third objective). RESULTS: The primary outcome analysis of 3 045 patients showed that patients with major cardiac complications were significantly older, with a higher prevalence of hypertension, coronary artery disease or congestive cardiac failure, and had undergone major surgery. In-hospital mortality for the cohort was 1.2%. CONCLUSIONS: The substantial burden of cardiovascular disease in patients presenting for non-cardiac surgery in Africa is shown in the principal findings of this study. The RCRI has moderate discrimination for major cardiac complications and major adverse cardiac events in African patients undergoing non-cardiac surgery.
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A 2021 study conducted an observational in Perioperative cardiovascular risk in non-cardiac surgery (n=3,045). Congestive cardiac failure vs. No congestive cardiac failure was evaluated on In-hospital postoperative cardiovascular complications (RR 11.5, 95% CI 5.36-24.64, p=<0.0001). In African patients aged 45 years and older undergoing non-cardiac surgery, a history of congestive cardiac failure was strongly associated with an increased risk of in-hospital postoperative cardiovascular complications (RR 11.5).
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