Perioperative Stroke and Associated Mortality after Noncardiac, Nonneurologic Surgery
ABSTRACT Stroke is a leading cause of morbidity and mortality in the United States and occurs in the perioperative period. The authors studied the incidence, predictors, and outcomes of perioperative stroke using the American College of Surgeons National Surgical Quality Improvement Program.
Data on 523,059 noncardiac, nonneurologic patients in the American College of Surgeons National Surgical Quality Improvement Program database were analyzed for the current study. The incidence of perioperative stroke was identified. Logistic regression was applied to a derivation cohort of 350,031 patients to generate independent predictors of stroke and develop a risk model. The risk model was subsequently applied to a validation cohort of 173,028 patients. The role of perioperative stroke in 30-day mortality was also assessed.
The incidence of perioperative stroke in both the derivation and validation cohorts was 0.1%. Multivariate analysis revealed the following independent predictors of stroke in the derivation cohort: age ≥ 62 yr, history of myocardial infarction within 6 months before surgery, acute renal failure, history of stroke, dialysis, hypertension, history of transient ischemic attack, chronic obstructive pulmonary disease, current tobacco use, and body mass index 35-40 kg/m² (protective). These risk factors were confirmed in the validation cohort. Surgical procedure also influenced the incidence of stroke. Perioperative stroke was associated with an 8-fold increase in perioperative mortality within 30 days (95% CI, 4.6-12.6).
Noncardiac, nonneurologic surgery carries a risk of perioperative stroke, which is associated with higher mortality. The models developed in this study may be informative for clinicians and patients regarding risk and prevention of this complication.
- SourceAvailable from: Nathaniel Greene
Advances in Anesthesia 01/2012; 30:97-129. DOI:10.1016/j.aan.2012.08.003
- "Defining the parameters that affect cerebral perfusion and understanding the pathophysiologic conditions that result in a supply and demand mismatch is of paramount concern for anesthesiologists. Stroke is one of the most devastating perioperative complications, and can occur with an incidence of 0.1% to 1.0% in patients undergoing noncardiac, non-neurological procedures, using national database statistics . It is difficult to estimate what percentage of these perioperative strokes are related to embolic phenomena versus hypoperfusion, but hypoperfusion was strongly implicated as a causative factor in the multicenter randomized controlled trial Perioperative Ischemic Evaluation Study (POISE), in which patients receiving perioperative beta blockade had a twofold increased risk of stroke compared with patients who received placebo . "
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ABSTRACT: Postural change during anesthesia has a complex effect on the systemic and cerebral circulations which can potentially decrease cerebral blood flow and oxygenation. Cerebral oximetry is emerging as a monitor of cerebral perfusion with widespread application in many types of surgery. The technology is based on the differential absorption of oxygenated and deoxygenated hemoglobin to near-infrared light. However, the dynamic coupling that exists between cerebral arterial, venous and cerebrospinal fluid volumes may influence oximetric readings during postural change. Interpretation of cerebral oxygen saturation measurement must account for these changes in cerebral physiology if monitoring is to predict neurological outcome.09/2013; 3(3). DOI:10.1007/s40140-013-0020-y
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