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Development and external validation of a prognostic model for ischaemic stroke after surgery
Katharina Platzbecker1, Stephanie D Grabitz1, Dana Raub1
1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
British Journal of Anaesthesia
|July 25, 2021
Summary
A new scoring system reliably identifies patients at high risk for stroke after noncardiac surgery. This tool aids in stratifying patients for future stroke prevention trials.
Area of Science:
- Medical research
- Clinical prediction models
- Stroke prevention
Background:
- A significant patient group faces elevated risk of postoperative ischemic stroke.
- Current identification methods for high-risk patients are insufficient.
- Noncardiac surgery patients require better risk assessment for stroke.
Purpose of the Study:
- Develop and validate a prognostic model to identify patients at high risk of ischemic stroke within one year after noncardiac surgery.
- Create a simplified scoring system for enhanced clinical applicability.
- Improve patient stratification for postoperative stroke risk.
Main Methods:
- Hospital registry study of adult patients undergoing noncardiac surgery (2005-2017).
- Logistic regression used to develop a predictive model for 1-year postoperative ischemic stroke.
- External validation and simplification to a scoring system (STRAS).
Main Results:
- The final model included 13 variables, achieving high predictive accuracy (AUC 0.89 development, 0.88 validation).
- Ischemic stroke occurred in 1.4% (development) and 0.5% (validation) of patients within one year.
- Decision curve analysis demonstrated superior net benefits compared to existing instruments.
Conclusions:
- Stroke after surgery (STRAS) screening effectively identifies patients at high risk for ischemic stroke post-surgery.
- STRAS risk stratification can guide recruitment for future randomized trials on stroke prevention.
- This tool enhances the ability to manage and prevent postoperative stroke.
