Acute Ischemic Stroke after Non-Cardiac, Non-Neurologic and Non-Major Vascular Surgery During Index Hospitalization: A Retrospective Matched Case-Control Study

10.6966/EDMJ.202409_11(3).0001

Chih-Tung Huang；Tzu-Shan Chen；Sheng-Han Lin

stroke ； acute ischemic stroke ； perioperative stroke ； risk of perioperative stroke ； non-cardiac surgery

E-Da Medical Journal

11卷3期（2024 / 09 / 01）

1 - 8

英文

Objective: Incidence and risk factors for acute ischemic stroke (AIS) during index hospitalization period following non-major surgery were not well characterized. Methods: This retrospective, matched case-control study was conducted by reviewing the medical records (from January 2019 to December 2022) in three general hospitals located in Kaohsiung City, Taiwan. Patients who presented with newly onset neurologic deficits after non-cardiac, non-neurologic, and non-major vascular surgery during the index hospital stay period were evaluated with brain imaging studies to confirm the development of AIS. The potential risk factors for perioperative AIS were compared with the randomly selected matched controls in a ratio of 1:5 from the same database. Results: A total of 103,348 patients were included in the 4-year study period and AIS was radiographically confirmed in 12 patients. Two AIS patients expired during the hospital stay period and all remaining AIS patients still experienced moderate-to-severe functional disability at hospital discharge. Multivariate logistic regression analysis illustrated that patients who received regular antiplatelet therapy (adjusted odds ratio [AOR] 5.22, 95% confidence interval [CI] 1.03 - 26.44; p = 0.046) and those who received intraoperative red blood cell (RBC) transfusions (AOR 52.21, 95% CI 4.15 - 656.46; p = 0.002) were the two most significant independent variables for perioperative AIS. Conclusions: Our study finds that incidence of perioperative AIS after non-cardiac, non-neurologic, and non-major vascular surgery was 0.01% with a high in-hospital mortality rate of 16.7%. Survivors suffered moderate-to-severe functional impairment. Patients taking regular antiplatelet therapy and those who required RBC transfusions intra-operatively, particularly during spinal surgery, were associated with higher risks of perioperative AIS.