Perioperative stroke-related mortality after non-cardiovascular, non-neurological procedures: A retrospective risk factor evaluation of common surgical comorbidities. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Reinert, Nathan J; Patel, Bansri M; Al-Robaidi, Khaled; Gao, Xiaotian; Fabio, Anthony; Jadhav, Ashutosh; Muluk, Visala S; Esper, Stephen A; Zuckerbraun, Brian S; Thirumala, Parthasarathy D
• Is Part Of: Journal of perioperative practice. Volume 31:Issue 3(2021)
• Page Start: 80
• Page End: 88
• Publication Date: 2021-03
• Subjects: Perioperative risk stratification / Perioperative stroke-related mortality / Diabetes / Atrial fibrillation / Asymptomatic carotid stenosis; Operating room nursing -- Periodicals; 617.9192
• DOI: 10.1177/1750458920911830
• Languages: English
• ISSNs: 2515-7949

Abstract

Background: Perioperative stroke-related mortality in the non-cardiovascular, non-neurological surgery population is an uncommon, yet devastating outcome. A combination of emboli and hypoperfusion may cause large vessel occlusions leading to perioperative strokes and mortality. Identifying independent risk factors for perioperative stroke-related mortality may enhance risk-stratification algorithms and preventative therapies. Objectives: This study utilised cause-of-death data to determine independent risk scores for common surgical comorbidities that may lead to perioperative stroke-related mortality, including atrial fibrillation and asymptomatic carotid stenosis. Methods: This retrospective, IRB-exempt, case–control study evaluated non-cardiovascular, non-neurological surgical patients in a claims-based database. ICD-10-CM and ICD-9-CM codes identified cause of death and comorbidity incidences, respectively. A multivariate regression analysis then established adjusted independent risk scores of each comorbidity in relation to perioperative stroke-related mortality. Results: Patients with atrial fibrillation were more likely (1.7 aOR, 95% CI (1.1, 2.8) p = 0.02) to die from perioperative stroke-related mortality than from other causes. No association was found with asymptomatic carotid stenosis. Further, in-hospital strokes (25.9 aOR, 95% CI (16.0, 41.8) p < 0.001) or diabetes (1.8 aOR, 95% CI (1.1, 2.9) p = 0.02) may increase perioperative stroke-related mortality risk. Conclusions: Atrial fibrillation, diabetes and in-hospital strokes may be independent risk factors for perioperative stroke-related mortality in the non-cardiovascular, non-neurological surgery population.