title: Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery.
abstract: BACKGROUND
  Perioperative stroke is a potentially catastrophic complication of surgery. Patients undergoing vascular surgery suffer from systemic atherosclerosis and are expected to be at increased risk for this complication. We studied the incidence, predictors, and outcomes of perioperative stroke after noncarotid major vascular surgery using the American College of Surgeons National Quality Improvement Program database.
  
  
  METHODS
  Forty-seven thousand seven hundred fifty patients undergoing noncarotid vascular surgery from 2005 to 2009 at nonVeterans Administration hospitals were identified from the American College of Surgeons National Quality Improvement Program database. An analysis of patients undergoing elective lower extremity amputation, lower extremity revascularization, or open aortic procedures was performed to determine the incidence, independent predictors, and 30-day mortality of perioperative stroke.
  
  
  RESULTS
  The overall incidence of perioperative stroke within 30 days of surgery (n=37,927) was 0.6%. Multivariate analysis revealed that each 1-year increase in age [odds ratio 1.02, 95% confidence interval (CI) (1.01 to 1.04)], cardiac history [1.42, (1.07 to 1.87)], female sex [1.47, (1.12 to 1.93)], history of cerebrovascular disease [1.72, (1.29 to 2.29)], and acute renal failure or dialysis dependence [2.03, (1.39 to 2.97)] were independent predictors of stroke. Only 15% (95% CI, 11%-20%) of strokes occurred on postoperative day 0 or 1. Perioperative stroke was associated with a 3-fold increase in 30-day all-cause mortality [3.36, (1.77 to 6.36)] and an increased median surgical length of stay from 6 (95% CI, 2 to 28) to 13 (95% CI, 3 to 43) days (P<0.001, WMWodds 2.5, 95% CI, 2.0 to 3.2) in a matched-cohort assessment.
  
  
  CONCLUSIONS
  Perioperative stroke is an important source of morbidity and mortality, as reflected by significant increases in median surgical length of stay and all-cause 30-day mortality. The independent predictors of stroke that we have identified in this population are not readily modifiable and the majority of strokes occurred after postoperative day 1. Additional studies are required to identify potentially modifiable intraoperative or postoperative risk factors of perioperative stroke.
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, 1H247 UH/Box 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA.
authors.forename: Milad
authors.initials: M
authors.lastname: Sharifpour
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Moore
authors.forename: Amy M
authors.initials: AM
authors.lastname: Shanks
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Didier
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: George A
authors.initials: GA
authors.lastname: Mashour
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*