Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes.
BACKGROUND
Perioperative acute ischemic stroke (AIS) is a recognized complication of noncardiac, nonvascular surgery, but few data are available regarding incidence and effect on outcome. This study examines the epidemiology of perioperative AIS in three common surgeries: hemicolectomy, total hip replacement, and lobectomy/segmental lung resection.


METHODS
Discharges for patients aged 18 yr or older who underwent any of the surgical procedures listed above were extracted from the Nationwide Inpatient Sample, an administrative database that contains 20% of all discharges from non-Federal hospitals each year, for years 2000 to 2004. Using appropriate International Classification of Diseases, 9th revision, Clinical Modification codes, patients with perioperative AIS were identified, as were comorbid conditions that may be risk factors for perioperative AIS. Multivariate logistic regression was performed to identify independent predictors of perioperative AIS and to ascertain the effect of AIS on outcome.


RESULTS
A total of 0.7% of 131,067 hemicolectomy patients, 0.2% of 201,235 total hip replacement patients, and 0.6% of 39,339 lobectomy/segmental lung resection patients developed perioperative AIS. For patients older than 65 yr, AIS rose to 1.0% for hemicolectomy, 0.3% for hip replacement, and 0.8% for pulmonary resection. Multivariate logistic regression analysis revealed renal disease (odds ratio, 3.0), atrial fibrillation (odds ratio, 2.0), history of stroke (odds ratio, 1.6), and cardiac valvular disease (odds ratio, 1.5) to be the most significant risk factors for perioperative AIS.


CONCLUSIONS
Perioperative AIS is an important source of morbidity and mortality associated with noncardiac, nonvascular surgery, particularly in elderly patients and patients with atrial fibrillation, valvular disease, renal disease, or previous stroke.
Bateman
Brian T
BT
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. BBateman@partners.org
Schumacher
H Christian
HC
Wang
Shuang
S
Shaefi
Shahzad
S
Berman
Mitchell F
MF
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy*; D015331:Cohort Studies; D003082:Colectomy; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000628:therapy*; D016015:Logistic Models; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult