Intraoperative Blood Pressure Variability and Early Postoperative Stroke: A Case-Control Study

Area of Science:

• Anesthesiology and Perioperative Medicine
• Neurology
• Transfusion Medicine

Background:

• Postoperative stroke is a serious complication following surgical procedures.
• Understanding risk factors is crucial for patient safety and improved outcomes.
• Intraoperative hemodynamic variability and transfusion practices are potential contributors.

Purpose of the Study:

• To investigate the association between intraoperative hemodynamic variability and postoperative stroke.
• To assess the impact of transfusion management on the risk of postoperative stroke.
• To identify independent risk factors for stroke after surgery.

Main Methods:

• A matched case-control study design was employed.
• Adult patients who experienced stroke within 72 hours of surgery were compared to controls.
• Key factors analyzed included fluid administration, blood product transfusion, vasopressor use, and hemodynamic variability (blood pressure and heart rate).

Main Results:

• The incidence of postoperative stroke was 9.3 per 100,000 procedures.
• Red blood cell (RBC) transfusion was independently associated with a significantly increased risk of stroke (OR, 10.10).
• Vasopressor use and longer procedure duration also increased stroke risk, but RBC transfusion was the strongest independent predictor.

Conclusions:

• Intraoperative hemodynamic variability (blood pressure and heart rate) was not found to be associated with an increased risk of postoperative stroke.
• Red blood cell transfusion emerged as a significant and independent risk factor for postoperative stroke.
• These findings underscore the critical role of transfusion management in mitigating stroke risk.