Cardiovascular outcomes and mortality in vascular surgical patients

Kruger, Elmar

Cardiovascular outcomes and mortality in vascular surgical patients

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Anaesthesia and Perioperative Medicine

Faculty

Faculty of Health Sciences

Abstract

Title: An observational cohort study of in-hospital mortality and adverse cardiovascular events in moderate- to high-risk elective vascular surgery at Groote Schuur Hospital. Background: Each year, over a million patients worldwide die within a month of elective, noncardiac surgery, with half of these deaths attributed to cardiovascular complications. There is a lack of data from low- and middle-income countries (LMIC) particularly in Sub Saharan Africa, where cardiovascular disease is the second leading cause of non-communicable disease. LMICs have a population five times that of their high-income counterparts. International studies show the highest incidence of cardiovascular complications occur in patients undergoing vascular surgery. The aims of this study were to document the burden of cardiovascular disease in South African vascular surgical patients, and the associated outcomes. Methods: We conducted an observational cohort study in patients aged ≥18 years undergoing elective intermediate- to high-risk vascular surgery at Groote Schuur Hospital (GSH). Data were collected in a combined Anaesthesia and Vascular Database at GSH. The primary outcome was postoperative in-hospital mortality rate, and the secondary outcome was the incidence of myocardial injury after noncardiac surgery (MINS). Postoperative screening for MINS was done using fifth generation, high sensitivity troponin T testing done on postoperative days 1, 2 and 3. Prognostically significant troponin thresholds, according to American Heart Association (AHA) guidelines, were used to diagnose MINS. Results: This study recruited 175 patients over an 18-month period. The in-hospital mortality in this cohort was 4.5% (8/175). MINS occurred in 15.4% (16/104) of patients who had troponin screening. Conclusion: The high-risk nature of patient and surgical factors places vascular surgery patients at a higher risk for perioperative mortality and MINS as compared to the general noncardiac population.