J Stroke.  2019 Sep;21(3):290-301. 10.5853/jos.2019.00304.

The Incidence of Perioperative Stroke: Estimate Using State and National Databases and Systematic Review

Affiliations
  • 1Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA. thirumalapd@upmc.edu
  • 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
  • 3Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

BACKGROUND AND PURPOSE
Perioperative stroke remains a devastating complication after surgical procedures, due to hemodynamic and inflammatory changes that increase the risk of strokes within 30 days following surgery. We aimed to assess the incidence of perioperative strokes in patients undergoing various surgical procedures and reach a national estimate.
METHODS
A retrospective cohort study was conducted using California State Inpatient Databases, State Emergency Department Databases, State Ambulatory Surgery and Services Databases, and the National Inpatient Sample (NIS) during the period 2008 to 2011 from the Healthcare Cost and Utilization Project. A systematic review was conducted using PubMed, Embase, and Web of Science databases to obtain published articles that reported the incidence of perioperative stroke in various surgical procedures.
RESULTS
Analysis of 3,694,410 surgical encounters from the state of California (mean┬▒standard deviation age: 52.4┬▒21.1 years) yielded an overall rate of perioperative stroke of 0.32% (n=11,759). The incidence of perioperative strokes was highest following neurological (1.25%), vascular (1.07%), and cardiac (0.98%) surgeries. The NIS database contained a total of 48,672,974 weighted hospitalizations and yielded a rate of perioperative stroke of 0.42% (n=204,549). The systematic review completed yielded 187 articles, which had an overall sample size of 184,922 and an incidence of perioperative stroke ranging from 0% to 13.86%. It is estimated that in any given year, there would be approximately 40,000 to 55,000 (0.33% to 0.46%) perioperative strokes nationally.
CONCLUSIONS
Our findings support further strategies to identify and stratify patients undergoing surgical procedures with a high incidence of perioperative strokes to improve patient counseling and a future potential treatment plan.

Keyword

Stroke; Postoperative complications; Incidence; Surgery; Perioperative period

MeSH Terms

Ambulatory Surgical Procedures
California
Cohort Studies
Counseling
Emergency Service, Hospital
Health Care Costs
Hemodynamics
Hospitalization
Humans
Incidence*
Inpatients
Perioperative Period
Postoperative Complications
Retrospective Studies
Sample Size
Stroke*
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