Perioperative stroke after general surgical procedures

Abstract

Perioperative cerebrovascular accidents after general surgical procedures are rare, but devastating and often fatal. The purpose of this study was to identify the perioperative, intraoperative, and postoperative factors associated with perioperative strokes after general surgical procedures. Over a five-year period, 19 patients of 24,641 general and vascular surgical procedures (0.08%) suffered a perioperative stroke. Patients undergoing carotid endarterectomies were excluded. These 19 patients were compared with a group of 19 patients matched for age and procedure. The strokes occurred in relation to the surgery as follows: 53% within 24 hours, 31% within one to seven days, and 16% within seven to thirty-six days. The overall perioperative mortality was 26%. In long-term follow-up, four patients died, two had complete recovery (11%), two had 90% recovery (11%), one had partial recovery (5%), and one remained completely disabled (5%). In comparing the groups, the significant factors contributing to perioperative stroke included hypertension, smoking, earlier neurological symptoms, and an abnormal rhythm on electrocardiogram. The most common factor for stroke was atrial fibrillation. Only one patient had an intracerebral hemorrhage. Although the exact mechanism of perioperative stroke remains uncertain, its association with abnormal cardiograms, lack of association with carotid bruits, and lack of intracerebral hemorrhage all suggest that emboli from the heart is the major cause in most patients. These data indicate that a perioperative stroke is associated with a very high mortality rate (26%) and is a potentially predictable complication in the majority of patients.