Risk Stratification for Cardiac Complications in Non-Cardiac Surgery Among Patients at Jos University Teaching Hospital

Perioperative cardiac events represent a significant cause of postoperative morbidity and mortality in non-cardiac surgery patients, particularly those with underlying cardiovascular disease. Systematic cardiac risk stratification before non-cardiac surgery remains inconsistently applied in Nigerian hospitals. This study develops and validates a locally adapted cardiac risk stratification approach for non-cardiac surgery patients at Jos University Teaching Hospital (JUTH), Plateau State, North Central Nigeria, from 2020 to 2023. A prospective cohort of 350 adult patients scheduled for intermediate-to-high-risk non-cardiac surgery was recruited. Preoperative cardiac risk was assessed using the Revised Cardiac Risk Index (RCRI). Cardiac events including myocardial infarction, heart failure, and arrhythmia were monitored within 30 days postoperatively. ECG, troponin levels, and echocardiography findings were correlated with RCRI scores. Thirty-day major adverse cardiac events occurred in 8.9% of patients. RCRI demonstrated moderate discrimination in this population (AUC 0.71), with locally prevalent conditions such as uncontrolled hypertension and heart failure due to peripartum cardiomyopathy reducing its predictive performance. An augmented risk model incorporating regional comorbidity patterns achieved superior discrimination (AUC 0.83). The study recommends adoption of the augmented risk model at JUTH, structured anaesthetic preassessment clinics, and cardiologist-surgeon perioperative consultation pathways in North Central Nigeria. Keywords: cardiac risk stratification, perioperative cardiac events, RCRI, non-cardiac surgery, Jos