Incidence and Risk Factors of Perioperative Stroke in Noncardiac, and Nonaortic and Its Major Branches Surgery

Abstract

Background: Perioperative stroke, defined as a stroke that occurs during an operation until 30 days postoperatively, is an uncommon but devastating complication. Studies regarding perioperative stroke in noncardiac and nonmajor vessels surgery are scarce.

Methods: Patients aged 18 years and older who underwent noncardiac, and nonaortic and its major branches surgery between January 2009 and December 2013 were included. A surgeon-matched control study forming a case-to-control ratio of 1:4 was conducted. Patients' characteristics, comorbidities, preoperative and perioperative stroke risks, stroke types, and types of surgical procedure were collected and analyzed by descriptive statistics. Multiple logistic regression analysis was used to identify significant risk factors of perioperative strokes (P <.05).

Results: Forty-two out of 55,648 noncardiovascular surgery patients developed perioperative strokes, resulting in an incidence of .075%. Age (adjusted OR 1.04; 95% CI 1-1.08, P = .42), valvular heart disease (adjusted OR 6.18; 95% CI 1.35-28.33, P = .019), previous stroke (adjusted OR 7.06; 95% CI 1.74-28.75, P = .006), emergency surgery (adjusted OR 8.13; 95% CI 2.05-32.25, P = .003), and postoperative hypotension (adjusted OR 5.1; 95% CI 1.11-23.45, P = .036) were significant predictors of perioperative strokes by multivariable analysis.

Conclusions: The incidence of perioperative stroke found was comparable to the previous similar studies. Advanced age, pre-existing valvular heart disease, previous stroke, emergency surgery, and postoperative hypotension were the significant risk factors determined in this study.

Keywords: Stroke; incidence; nonaortic; noncardiac; perioperative; predictors; risk factors; surgery.