Hong Wang1, Shuang-Ling Li2, Jing Bai3, Dong-Xin Wang4. 1. Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China; Intensive Care Unit, First Hospital, Baoding City, Hebei Province, China. 2. Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China. Electronic address: lishuangling888@hotmail.com. 3. Department of Internal Neurology, Peking University First Hospital, Beijing, China. 4. Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China.
Abstract
OBJECTIVE: To identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery. DESIGN: Retrospective study. SETTING: University-affiliated hospital. PARTICIPANTS: The study comprised 100 patients with PAIS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data of 351,531 patients who underwent noncardiac, nonvascular, and non-neurologic surgery in the authors' hospital between January 2003 and December 2016 were retrospectively reviewed. PAIS occurred in 100 patients. The incidence of PAIS (overall 2.8/10,000) was significantly lower in patients <45 years old (0.12/10,000) than in patients >75 years old (15.79/10,000; p < 0.001). The in-hospital mortality rate was higher among patients with PAIS (26%) than among patients without PAIS (0.34%; p < 0.01). Multiple logistic regression analysis revealed the following independent risk factors for in-hospital mortality: preoperative atrial fibrillation (odds ratio [OR] 9.013, 95% confidence interval [CI] 1.400-58.016; p = 0.021), disturbance of consciousness as the first PAIS symptom (OR 5.561, 95% CI 1.521-20.332; p = 0.009), no anticoagulant/antiplatelet therapy after PAIS (OR 8.196, 95% CI 1.017-66.065; p= 0.048), diuretic treatment (OR 4.942, 95% CI 1.233-19.818; p = 0.024), and pulmonary infection (OR 6.979, 95% CI 1.853-26.291; p = 0.004). CONCLUSIONS: The risk of PAIS after noncardiac, nonvascular, and non-neurologic surgery significantly increased with age, and development of PAIS increased the mortality rate. Among these patients, the independent predictors of in-hospital mortality were preoperative atrial fibrillation, disturbance of consciousness as the first PAIS symptom, no anticoagulant/antiplatelet therapy after PAIS, diuretic treatment, and pulmonary infection.
OBJECTIVE: To identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery. DESIGN: Retrospective study. SETTING: University-affiliated hospital. PARTICIPANTS: The study comprised 100 patients with PAIS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data of 351,531 patients who underwent noncardiac, nonvascular, and non-neurologic surgery in the authors' hospital between January 2003 and December 2016 were retrospectively reviewed. PAIS occurred in 100 patients. The incidence of PAIS (overall 2.8/10,000) was significantly lower in patients <45 years old (0.12/10,000) than in patients >75 years old (15.79/10,000; p < 0.001). The in-hospital mortality rate was higher among patients with PAIS (26%) than among patients without PAIS (0.34%; p < 0.01). Multiple logistic regression analysis revealed the following independent risk factors for in-hospital mortality: preoperative atrial fibrillation (odds ratio [OR] 9.013, 95% confidence interval [CI] 1.400-58.016; p = 0.021), disturbance of consciousness as the first PAIS symptom (OR 5.561, 95% CI 1.521-20.332; p = 0.009), no anticoagulant/antiplatelet therapy after PAIS (OR 8.196, 95% CI 1.017-66.065; p= 0.048), diuretic treatment (OR 4.942, 95% CI 1.233-19.818; p = 0.024), and pulmonary infection (OR 6.979, 95% CI 1.853-26.291; p = 0.004). CONCLUSIONS: The risk of PAIS after noncardiac, nonvascular, and non-neurologic surgery significantly increased with age, and development of PAIS increased the mortality rate. Among these patients, the independent predictors of in-hospital mortality were preoperative atrial fibrillation, disturbance of consciousness as the first PAIS symptom, no anticoagulant/antiplatelet therapy after PAIS, diuretic treatment, and pulmonary infection.
Authors: Nathan J Reinert; Bansri M Patel; Qasem N AlShaer; Liwen Wu; Stephen Wisniewski; Eric S Hager; Mitchell R Dyer; Parthasarathy D Thirumala Journal: Neurologist Date: 2021-11-30 Impact factor: 1.398