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Published on: October 20, 2017
[Epidemiology of cerebral perioperative vascular accidents]
B Rozec1, R Cinotti1, Y Le Teurnier1
1Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
Insights
Postoperative stroke is a rare but serious complication, particularly after general surgery. It indicates surgical team skill and increases mortality risk.
Area of Science:
- Medical research
- Surgical complications
- Neurology
Background:
- Stroke is a known complication following cardiac and carotid surgery.
- Limited data exists on postoperative stroke in general non-cardiac, non-carotid surgery.
- High stroke morbidity and mortality necessitate further investigation.
Purpose of the Study:
- To analyze recent literature on postoperative stroke.
- To compare stroke incidence across different surgical types.
- To identify risk factors and outcomes associated with postoperative stroke.
Main Methods:
- Systematic review of Medline and Ovid databases.
- Inclusion of national and European epidemiologic data.
- Consultation of expert recommendations and reference texts.
Main Results:
- Cardiac surgery: 1.2-10% incidence, often peroperative or within 48 hours.
- Carotid surgery: 1-20% incidence, technique and skill dependent.
- General surgery: Rare (0.15%), typically delayed onset, higher in elderly and high-risk patients (hip fracture, vascular surgery).
- Postoperative stroke significantly increases perioperative mortality.
Conclusions:
- Postoperative stroke serves as a quality indicator for surgical teams.
- Stroke onset timing varies by surgical procedure.
- Associated with increased postoperative mortality.
Objectives:
Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature.
Article Type:
Systematic review.
Data Sources:
Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters.
Results:
In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients.
Conclusion:
Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.
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