Perioperative stroke

Jonathon P Fanning^{1

2

3

4

5}, Bruce C V Campbell^{6

7

8}, Richard Bulbulia^{9

10}, Rebecca F Gottesman¹¹, Sang-Bae Ko¹², Thomas F Floyd¹³, Steven R Messé¹⁴

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
² Anaesthesia & Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
³ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
⁴ The George Institute for Global Health, Sydney, New South Wales, Australia. j.fanning@uq.edu.au.
⁵ Nuffield Department of Population Health, University of Oxford, Oxford, UK. j.fanning@uq.edu.au.
⁶ Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁷ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
⁸ Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.
⁹ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
¹⁰ Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
¹¹ National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
¹² Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
¹³ Department of Anaesthesiology & Pain Management, Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁴ Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

PMID: 38238382
DOI: 10.1038/s41572-023-00487-6

Review

Perioperative stroke

Jonathon P Fanning et al. Nat Rev Dis Primers. 2024.

. 2024 Jan 18;10(1):3.

doi: 10.1038/s41572-023-00487-6.

Authors

Jonathon P Fanning^{1

2

3

4

5}, Bruce C V Campbell^{6

7

8}, Richard Bulbulia^{9

10}, Rebecca F Gottesman¹¹, Sang-Bae Ko¹², Thomas F Floyd¹³, Steven R Messé¹⁴

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
² Anaesthesia & Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
³ Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. j.fanning@uq.edu.au.
⁴ The George Institute for Global Health, Sydney, New South Wales, Australia. j.fanning@uq.edu.au.
⁵ Nuffield Department of Population Health, University of Oxford, Oxford, UK. j.fanning@uq.edu.au.
⁶ Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁷ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
⁸ Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.
⁹ Nuffield Department of Population Health, University of Oxford, Oxford, UK.
¹⁰ Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
¹¹ National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
¹² Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
¹³ Department of Anaesthesiology & Pain Management, Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁴ Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

PMID: 38238382
DOI: 10.1038/s41572-023-00487-6

Abstract

Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.

PubMed Disclaimer

References

1. International Surgical Outcomes Study group Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br. J. Anaesth. 117, 601–609 (2016). - DOI
1. Mashour, G., Moore, L., Lele, A., Robicsek, S. & Gelb, A. Perioperative care of patients at high risk for stroke during or after non-cardiac, non-neurologic surgery: consensus statement from the society for neuroscience in anesthesiology and critical care. J. Neurosurg. Anesthesiol. 26, 273–285 (2014). An original authoritative consensus statement, endorsed by the Society for Neuroscience in Anesthesiology and Critical Care, provides evidence-based guidelines for a previously under-represented patient cohort. It offers a structured risk stratification methodology and outlines best practices for multidisciplinary teams. - PubMed - DOI
1. Mashour, G., Shanks, A. & Kheterpal, S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology 114, 1289–1296 (2011). This study presents comprehensive data regarding the incidence and mortality of perioperative stroke from 523,059 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent noncardiac, non-neurological surgery. This is foundational in highlighting the risk factors and significant morbidity and mortality associated with perioperative stroke. - PubMed - DOI
1. Wilcox, T., Smilowitz, N. R., Xia, Y. & Berger, J. S. Cardiovascular risk scores to predict perioperative stroke in noncardiac surgery. Stroke 50, 2002–2006 (2019). This study compares several scoring tools used clinically for perioperative stroke risk prediction. It reports excellent risk discrimination for perioperative stroke in patients undergoing noncardiac surgery using the myocardial infarction or cardiac arrest risk score and the American College of Surgeons surgical risk calculator. - PubMed - PMC - DOI
1. Nepogodiev, D. et al. Global burden of postoperative death. Lancet 393, 401 (2019). - PubMed - DOI

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Nature Publishing Group
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Perioperative stroke

Affiliations

Perioperative stroke

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical