Risk factors for perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery

Objective To assess the incidence, risk factors, and outcomes of perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery. Methods A total of 21 419 in-patients who were older than 65 years undergoing nonneurologic and noncardiovascular surgery in Peking University People′s Hospital from January 2010 to May 2016 were retrospectively recruited in this study.The patients were divided into two groups: patients with perioperative stroke were allocated in stroke group, and the other patients were in the non-stroke group.The following variables were compared between the 2 groups: demographics, comorbidities, preoperative laboratory tests, characteristics of operation and anesthesia and prognosis.A multivariate Logistic regression was used to evaluate the risk factors for perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery. Results Stroke occurred in twenty-two patients (0.1%), and the risk factors were: American Society of Anesthesiologists (ASA) classification (P=0.031; OR=2.395; 95%CI: 1.082-5.301), previous stroke or transient ischemic attack (P<0.001; OR=61.305; 95%CI: 19.311-194.617), diabetes on insulin (P=0.015; OR=3.488; 95%CI: 1.275-9.540), carotid stenosis (P=0.001; OR=15.157; 95%CI: 3.068-74.885) and preoperative anemia (P=0.032; OR=3.272; 95%CI: 1.108-9.662). Perioperative stroke led to prolong the hospital stay from 10(6, 17) days to 30(23, 55) days (Z=3.302, P<0.001). The mortality was 18.2% in the stroke group and 0.1% in those without perioperative stroke (P<0.001). Conclusion The independent predictors of stroke in this population are ASA classification, previous stroke or transient ischemic attack, diabetes on insulin, carotid stenosis and preoperative anemia.Patients with these characteristics deserve more carefully perioperative management. Key words: Aged; Perioperative period; Stroke; Risk factors