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

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.

Conclusion: s 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.

Keywords: Incidence; Perioperative period; Postoperative complications; Stroke; Surgery.

Figure 1.

The overall Incidence of perioperative stroke according to different age groups and the highest three surgical categories in each age group.

Figure 2.

Associated comorbidities in patients who suffered from a perioperative stroke in the state of California during 2008 to 2011. (A) The association between the number of comorbidities and the incidence of perioperative stroke, as well as the prevalence of the count of comorbidities in patients who suffered from a perioperative stroke. (B) The incidence of perioperative stroke with different comorbidities and the prevalence of those comorbidities in patients who suffered from a perioperative stroke.