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Risk for stroke after elective noncarotid vascular surgery

David A Axelrod1, James C Stanley, Gilbert R Upchurch

  • 1Section of Vascular Surgery, Department of Surgery, Robert Wood Johnson Scholars Program, University of Michigan School of Medicine, University Hospital 2210D THCC/0329, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0329, USA.

Journal of Vascular Surgery
|January 14, 2004
PubMed

Insights

Stroke after noncarotid vascular surgery is rare but significantly increases mortality and hospital stay. Previous stroke history and illness severity are key risk factors, necessitating careful patient management.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Critical Care Medicine

Background:

  • Patients with peripheral vascular disease often have systemic atherosclerosis, increasing stroke risk.
  • The impact of cerebrovascular events on outcomes of noncarotid vascular surgery is not well understood.

Purpose of the Study:

  • To determine the incidence of perioperative stroke after noncarotid peripheral vascular surgery.
  • To identify independent risk factors for stroke.
  • To quantify the effect of postoperative stroke on mortality and length of stay.

Main Methods:

  • Analysis of data from the Veterans Affairs National Surgery Quality Improvement Project and patient treatment files (1997-2000).
  • Inclusion of patients undergoing abdominal aortic aneurysmectomy, aortobifemoral bypass, lower extremity bypass, and major lower extremity amputation.
  • Logistic and linear regression analyses to identify risk factors and assess the impact of stroke on mortality and length of stay.

Main Results:

  • Stroke incidence ranged from 0.4% to 0.6% across procedures.
  • Independent stroke risk factors included preoperative ventilation, prior stroke/transient ischemic attack, postoperative myocardial infarction, and return to the operating room.
  • Postoperative stroke significantly increased perioperative mortality (OR, 6.3) and length of stay (48% increase).

Conclusions:

  • Stroke is infrequent but serious after noncarotid peripheral vascular surgery.
  • Previous stroke history and overall illness severity are primary stroke risk factors.
  • Patients with these risk factors require focused assessment and management of modifiable risk factors.
Abstract

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