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Outcomes following perioperative stroke in noncardiac and cardiac surgical patients Farmer, Jaycee


Background: Perioperative stroke is a cerebrovascular event occurring during or after surgery that can result in devastating and often unrecoverable outcomes. The primary objective of this thesis project was to identify independent predictors of 30-day mortality, adverse discharge, and length of hospital stay (LOS) in both noncardiac and cardiac surgery patients. The secondary objective was to examine temporal trends in poor outcome throughout the study period. Methods: This retrospective cohort study included noncardiac and cardiac surgical patients who experienced a perioperative stroke in the American College of Surgeons National Surgical Quality Improvement Program database between 2005 and 2020. The data included patient demographics, comorbidities, stroke as well as surgical and anesthetic variables. Least absolute shrinkage and selection operator (LASSO) was used to examine variables associated with 30-day mortality (primary outcome), adverse discharge (death or a non-home facility, only available after 2010), and LOS in multivariable logistic models. Results: We identified 14,386 noncardiac and 906 cardiac surgical patients who experienced a perioperative stroke meeting our inclusion criteria. Mortality rates were 24.6% and 14.8% for noncardiac and cardiac stroke patients, respectively. Median [interquartile range] LOS was 9 [4–21] days for noncardiac patients and 13 [9–21] days for cardiac patients. Independent predictors associated with increased risk of mortality after stroke in both cohorts included increasing age, postoperative comorbidities, perioperative transfusion, and fewer days from operation to stroke. Operation year was associated with decreased LOS in both noncardiac and cardiac stroke populations, but not mortality or adverse discharge. Conclusion: We identified several independent predictors of poor outcome following perioperative stroke in noncardiac and cardiac surgical patients, including potentially modifiable risk factors such as perioperative transfusion and concurrent postoperative complications. These findings are novel and warrant further investigation to identify mechanisms and possible interventions to improve outcomes after perioperative stroke.

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