Raising the Alarm on Brain Attacks in Surgical Patients

Are We Doing Enough to Prevent and Treat Postoperative Strokes?

Published in: Anesthesiology, Volume 127, pages 3-5 (July 2017). doi: 10.1097/ALN.0000000000001686

Posted on RAND.org on January 15, 2021

by Laurent G. Glance, Robert G. Holloway

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The incidence of postoperative strokes in patients undergoing noncardiac, nonneurologic surgery is between 0.1 and 0.7%. Previous studies reported that patients with a history of ischemic stroke are two to three times more likely to experience a postoperative stroke. In this issue of Anesthesiology, Christiansen et al. report that a history of stroke within 3 months of emergency noncardiac, nonintracranial surgery is associated with a significantly increased risk of a recurrent postoperative stroke using data on 146,694 acute surgeries from the Danish National Patient Registry (DNRP). Specifically, 10% of patients with a history of ischemic stroke within 3 months had a postoperative stroke compared with 2 to 3% of patients with a history of stroke more than 3 months ago and 0.3% in patients with no previous stroke. In a previous study reported in the Journal of the American Medical Association, based on 481,183 elective surgeries in the DNRP, this same group reported similar time effects on the risk of postoperative stroke in patients undergoing elective noncardiac surgery: 12.0% in patients with stroke within 3 months, 4.5% in patients with stroke between 3 and 6 months, 1.0 to 2.0% if more than 6 months, and 0.1% in patients with no previous stroke. Unlike the Danish database, previous studies in the United States that reported a much lower risk of recurrent strokes were based on databases (the Nationwide Inpatient Sample and the American College of Surgeons National Surgical Quality Improvement Program database) that grouped all previous strokes together. These databases did not include information on how much time had elapsed between previous strokes and surgery.

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