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Towards the quantification of perioperative cardiovascular risk in the African context: A sub-analysis of the South African Surgical Outcomes Study and the African Surgical Outcomes Study

C S Alphonsus, H-L Kluyts, V Gobin, A Elkhogia, F D Madzimbamuto, J Tumukunde, A O Omigbodun, C Youssouf, Ryad Mehyaoui, D M Munlemvo, A Basenero, A Antwi-Kusi, D Z Ashebir, A K Ndonga, Z W Ngumi, C M Sani, A L Samateh, T E Madiba, R M Pearse, B M Biccard, on behalf of the African Surgical Outcomes Study (ASOS) investigators

Abstract


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.

 


Authors' affiliations

C S Alphonsus, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa; Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

H-L Kluyts, Department of Anaesthesiology, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa

V Gobin, Ministry of Health and Quality of Life, Jawaharlal Nehru Hospital, Rose Belle, Mauritius

A Elkhogia, Department of Anaesthesia, Tripoli University Hospital, Tripoli, Libya

F D Madzimbamuto, Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe

J Tumukunde, Department of Anaesthesia, School of Medicine, Makerere University, Kampala, Uganda

A O Omigbodun, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria

C Youssouf, Anesthésie-Réanimation & Urgences, Centre Hospitalier Universitaire Du Point G, Bamako, Mali

Ryad Mehyaoui, Department of Anaesthesia and Intensive Care, Cardiovascular Surgery, Medecine Faculty of Algiers, Hospital Dr Maouche.M.A (Ex CNMS), Algiers, Algeria

D M Munlemvo, Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA

A Basenero, Ministry of Health and Social Services Namibia, Windhoek, Namibia

A Antwi-Kusi, Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

D Z Ashebir, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

A K Ndonga, Department of Surgery, Mater Misericordiae Teaching Hospital, Nairobi, Kenya

Z W Ngumi, Department of Anaesthesia, School of Medicine, College of Health Sciences, University of Nairobi, Kenya

C M Sani, Department of Anesthesiology, Intensive Care and Emergency, National Hospital of Niamey, Republic of Niger

A L Samateh, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia

T E Madiba, Gastrointestinal Cancer Research Group, Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

R M Pearse, Department of Intensive Care Medicine, Queen Mary University of London, UK

B M Biccard, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

on behalf of the African Surgical Outcomes Study (ASOS) investigators, ASOS

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Keywords

Africa; Perioperative risk; Mortality; Cardiovascular complications

Cite this article

South African Medical Journal 2021;111(11):1065-1069. DOI:10.7196/SAMJ.2021.v111i11.15848

Article History

Date submitted: 2021-11-05
Date published: 2021-11-05

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