[Epidemiology of cerebral perioperative vascular accidents]

Abstract

Objectives: Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature.

Article type: Systematic review.

Data sources: Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters.

Results: In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients.

Conclusion: Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.

Keywords: Accident vasculaire cérébral; Cardiac surgery; Carotid surgery; Chirurgie cardiaque; Chirurgie carotidienne; Chirurgie générale; Chirurgie non cardiaque et non carotidienne; Facteurs de risque; General surgery; Horaire de survenue; Marqueur de qualité; Mortality; Mortalité; Non-cardiac non-carotid surgery; Onset time; Postoperative period; Période postopératoire; Quality marker; Risk factors; Stroke.