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Perioperative stroke and myocardial infarction in urologic surgery

Da David Jiang1, Kyle A Gillis, Yiyi Chen

  • 1Department of Urology, Oregon Health and Science University, Portland, Oregon, USA.

The Canadian Journal of Urology
|June 15, 2021
PubMed

Insights

Urologic surgery carries a small risk of perioperative stroke (0.14%) and myocardial infarction (0.36%). Cystectomy is the highest risk procedure, with older age, hypertension, and cancer increasing risk.

Area of Science:

  • Urology
  • Cardiovascular Surgery
  • Neurology

Background:

  • Perioperative stroke and myocardial infarction are rare but severe complications following surgical procedures.
  • A comprehensive understanding of these risks within urologic surgery is lacking.

Purpose of the Study:

  • To identify urologic procedures and patient factors associated with the highest risk of perioperative stroke and myocardial infarction.
  • To analyze the association between these complications and 30-day mortality.

Main Methods:

  • Analysis of the National Surgical Quality Improvement Program data from 2008-2017.
  • Inclusion of urologic procedures and identification of patients experiencing perioperative stroke or myocardial infarction.
  • Multivariable logistic regression to determine risk factors and mortality association.

Main Results:

  • Incidence rates: 0.14% for stroke and 0.36% for myocardial infarction among 281,744 cases.
  • Highest risk procedure: Cystectomy (Stroke OR 3.3, MI OR 7.2).
  • Key risk factors: Age ≥ 70, hypertension, disseminated cancer. Significantly increased 30-day mortality for affected patients.

Conclusions:

  • Perioperative stroke and myocardial infarction are uncommon yet serious complications in urologic surgery.
  • Cystectomy presents the highest procedural risk.
  • Patient age, hypertension, and disseminated cancer are significant preoperative risk factors.

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