Perioperative cardiovascular risk stratification and outcomes in adult patients undergoing major non-cardiac surgery at Moi Teaching And Referral Hospital, Eldoret, Kenya

Abstract

Background: Pre-operative cardiac evaluation of patients undergoing noncardiac surgery is routinely done to mitigate against adverse cardiovascular events, but the clinical benefit of this approach remains uncertain in low and middle-income countries (LMICs).

Objective: To determine the peri-operative cardiovascular risk category and adverse outcomes of patients undergoing elective major  non-cardiac surgery at the Moi Teaching and Referral Hospital (MTRH), Kenya.

Methods: This was prospective observational study. Participants ≥40 years old, scheduled for elective major non-cardiac surgery were  recruited between March and August 2022. A focused cardiovascular clinical evaluation, serum lipid profile, blood glucose level, renal  function test, electrocardiography and echocardiography data were collected. Risk stratification was done using the Revised Cardiac Risk  Index (RCRI). Postoperative follow up for acute coronary syndromes, worsening heart failure, unstable arrythmias in the first 48 hours, thereafter for all-cause mortality at 30 days.

Results: Two hundred and forty-three participants were recruited. Their mean age was 58.5  years and 61.3% were females. The prevalent cardiovascular disease risk factors were: hypertension (38%), diabetes mellitus (9.1%),  dyslipidaemia (28%), obesity (18%) and cigarette smoking (6.6%). Diabetes (9.1%), Heart failure (2.1%), previous stroke or transient  ischemic attack (1.2%) and chronic kidney disease (1.6%) were the perioperative cardiovascular complications risk factors present. Only  3(1.2%) of the participants were in the high-risk category (RCRI score of ≥3). Worsening HF was the main adverse cardiovascular outcome occurring in 4(1.6%) participants, 2(0.8%) had cardiovascular death.

Conclusion: Patients undergoing elective non-cardiac surgery at  MTRH are low risk with an attendant low cardiovascular events.