Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study

Area of Science:

• Anesthesiology
• Neurology
• Cardiovascular Surgery

Background:

• Postoperative stroke is a serious complication following surgery.
• Embolism from the heart or great vessels is the most common proposed cause.
• The impact of intraoperative hypotension on stroke development is not well understood.

Purpose of the Study:

• To investigate the association between intraoperative hypotension and the occurrence of postoperative ischemic stroke.
• To determine if the duration of hypotension influences stroke risk.

Main Methods:

• A case-control study included 48,241 patients undergoing noncardiac, nonneurosurgical procedures.
• 42 stroke cases were matched with 252 control patients.
• Conditional logistic regression analyzed the effect of hypotension duration on stroke risk within 10 days post-surgery.

Main Results:

• A statistically significant association was found between the duration of intraoperative hypotension and postoperative stroke.
• Specifically, a mean blood pressure decrease exceeding 30% from baseline was linked to stroke occurrence.
• This association remained significant after adjusting for confounders and multiple testing.

Conclusions:

• Intraoperative hypotension may contribute to the development of postoperative ischemic stroke.
• Sustained reductions in mean blood pressure (over 30% from baseline) are associated with increased stroke risk.
• Careful monitoring and management of blood pressure during surgery are crucial.