Newly Published
Perioperative Medicine  |   May 2017
Risks of Cardiovascular Adverse Events and Death in Patients with Previous Stroke Undergoing Emergency Noncardiac, Nonintracranial Surgery: The Importance of Operative Timing
Author Notes
  • From The Cardiovascular Research Center, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (M.N.C., C.A., G.H.G., M.E.J.); Department of Cardiology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark (C.A.); Department of Health Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); Anesthesiology and Critical Care Trials and Interdisciplinary Outcome Network, Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin (R.D.S.); and The Pain Clinic, Department of Anesthesiology, Næstved Hospital, Næstved, Denmark (P.F.J.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication June 20, 2016. Accepted for publication March 13, 2017.
    Submitted for publication June 20, 2016. Accepted for publication March 13, 2017.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Christiansen: The Cardiovascular Research Center, Herlev-Gentofte Hospital, University of Copenhagen, Denmark, Kildegårdsvej 28, 2900 Hellerup, Denmark. mia_nielsen7@hotmail.com or mia.nielsen.christiansen.01@regionh.dk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems
Perioperative Medicine   |   May 2017
Risks of Cardiovascular Adverse Events and Death in Patients with Previous Stroke Undergoing Emergency Noncardiac, Nonintracranial Surgery: The Importance of Operative Timing
Anesthesiology Newly Published on May 18, 2017. doi:10.1097/ALN.0000000000001685
Anesthesiology Newly Published on May 18, 2017. doi:10.1097/ALN.0000000000001685
Abstract

Background: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown.

Methods: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14 days), propensity-score matching was performed.

Results: Of 146,694 nonvascular surgeries (composing 98% of all emergency surgeries), 5.3% had previous stroke (mean age, 75 yr [SD = 13]; 53% women, 50% major orthopedic surgery). Antithrombotic treatment and atrial fibrillation were more frequent and general anesthesia less frequent in patients with previous stroke (all P < 0.001). Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained increased for stroke within 3 to 9 months (10.3 and 12.3%; OR = 1.93 [95% CI, 1.55 to 2.40] and 1.20 [95% CI, 0.98 to 1.47]) and stroke more than 9 months (8.8 and 11.7%; OR = 1.62 [95% CI, 1.43 to 1.84] and 1.20 [95% CI, 1.08 to 1.34]) compared with no previous stroke (2.3 and 4.8% events). Major adverse cardiovascular events were significantly lower in 323 patients undergoing immediate surgery (21%) compared with 323 successfully propensity-matched early surgery patients (29%; P = 0.029).

Conclusions: Adverse cardiovascular outcomes and mortality were greatly increased among patients with recent stroke. However, events were higher 4 to 14 days after stroke compared with 1 to 3 days after stroke.