Development and external validation of a prognostic model for ischaemic stroke after surgery. (November 2021)

• Record Type: Journal Article
• Authors: Platzbecker, Katharina; Grabitz, Stephanie D.; Raub, Dana; Rudolph, Maíra I.; Friedrich, Sabine; Vinzant, Nathan; Kurth, Tobias; Weimar, Christian; Bhatt, Deepak L.; Nozari, Ala; Houle, Timothy T.; Xu, Xinling; Eikermann, Matthias
• Is Part Of: British journal of anaesthesia. Volume 127:Number 5(2021)
• Page Start: 713
• Page End: 721
• Publication Date: 2021-11
• Subjects: anticoagulation -- ischaemic stroke -- prognostic factor -- stroke prevention -- surgery; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2021.05.035
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: There is an under-recognised patient cohort at elevated risk of postoperative ischaemic stroke. We aimed to develop and validate a prognostic model for the identification of such patients at high risk of ischaemic stroke within 1 yr after noncardiac surgery. Methods: This was a hospital registry study of adult patients undergoing noncardiac surgery between 2005 and 2017 at two independent healthcare networks in Massachusetts, USA without a preoperative indication for therapeutic anticoagulation. Logistic regression was used to fit a model from a priori defined candidate predictors for the outcome 1 yr postoperative ischaemic stroke. To enhance clinical applicability, the model was simplified to a scoring system and externally validated. Results: In the development ( n =107 756) and validation ( n =141 724) cohorts, 1.4% and 0.5% of patients had an ischaemic stroke up to 1 yr postoperatively. The final model included 13 variables (patient characteristics, comorbidities, procedural factors), considering sub-models conditional on a previous history of ischaemic stroke. Areas under the curve were 0.89 (95% confidence interval 0.89–0.90) and 0.88 (95% confidence interval 0.86–0.89) in the development and validation cohorts. Decision curve analysis indicated positive net benefits superior to other prediction instruments. Conclusions: Stroke after surgery (STRAS) screening can reliably identify patients with a high risk for ischaemic stroke during the first year after surgery. A STRAS-guided risk stratification may inform the recruitment to future randomised trials testing the efficacy of treatments for the prevention of postoperative ischaemic stroke.