Clinical and Prognostic Features of Perioperative Stroke: A Multicenter Retrospective Cohort Study

Perioperative stroke constitutes a major subset of in-hospital stroke. Evidence is lacking on whether procedure-specific risk profiles exist and how they influence functional recovery. We aimed to identify distinct clinical features and procedure-specific risk factors associated with perioperative stroke.

We retrospectively analyzed a 4-year cohort of patients with in-hospital stroke from 5 tertiary hospitals across China. Clinical data were systematically extracted through electronic medical record review. Ninety-day functional outcomes were assessed. Multivariate linear regression was performed to identify factors associated with 90-day outcomes in perioperative stroke.

Out of 1,048,566 hospitalized patients, 166 (0.02%) patients developed in-hospital stroke. Among them, 158 patients completed the 90-day follow-up, with 100 males (63.29%) and a median age of 69 years (IQR: 61-76). Sixty-three (39.87%) had perioperative stroke, with the highest proportion (13.92%) occurring in the cardiology/cardiothoracic surgery departments. Delayed recognition (4 h [IQR: 1.58-24.00] vs. 2 h [IQR: 1.00-5.50], p = 0.020), higher NIHSS scores (12 [IQR: 5-30] vs. 9 [IQR: 4-16], p = 0.045), and lower proportion of reperfusion therapy (5.56% vs. 28.21%, p = 0.003) were observed in patients with perioperative ischemic stroke compared to those with non-perioperative stroke. In subgroup analysis, cardiovascular surgery-related ischemic stroke patients had higher NIHSS scores (20 [IQR: 8-35] vs. 8 [IQR: 5-20], p = 0.035) and 90-day modified Rankin scale scores (4 [IQR: 2-6] vs. 2 [IQR: 1-4], p = 0.039) than those non-cardiovascular surgical counterparts. Additionally, they exhibited a trend toward a higher 90-day mortality rate (33.33% vs. 10.71%; OR, 4.17 [95% CI: 1.07 to 20.83]; p = 0.052).

Perioperative in-hospital stroke exhibits distinct clinical characteristics. Cardiovascular-related surgery is associated with worse functional outcomes.