title: 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.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Thadpaveen
authors.initials: T
authors.lastname: Vasivej
authors.affiliation: Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. Electronic address: sporncha@medicine.psu.ac.th.
authors.forename: Pornchai
authors.initials: P
authors.lastname: Sathirapanya
authors.affiliation: Occupational Health Unit, Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Chanon
authors.initials: C
authors.lastname: Kongkamol
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D059035:Perioperative Period; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors
keywords: Stroke; incidence; nonaortic; noncardiac; perioperative; predictors; risk factors; surgery