Perioperative Stroke Impact on Morbidity and In-Hospital Mortality in Non-Cardiovascular Non-Neurological Surgeries: State Inpatient Database Study

Abstract

Background: Perioperative stroke, which occurs within 30 days following surgery, can increase morbidity and mortality. The prior might reduce surgical interventions’ clinical effectiveness, carrying significant impact on patients, their families, and healthcare resources utilization. We examined the impact of perioperative stroke on morbidity and mortality in patients undergoing non-cardiovascular non-neurological surgeries.

Methods: We performed a retrospective cohort study utilizing State Inpatient Database (SID) available from the Health Cost Utilization Project (HCUP) between 2008 and 2011. The databases above can distinguish between previous and new strokes by providing the “present on admission” variable. We used multivariable logistic regression to assess stroke as an independent predictor of morbidity and mortality after adjusting for other covariables.

Results: From the SID, a total of 1,206,057 inpatient discharge records were identified. The incidence of perioperative stroke, in-hospital mortality, and morbidity was 0.14%, 0.54%, and 8.1%. Multivariate logistic regression showed that perioperative stroke is an independent predictor of morbidity (odds ratio (OR) = 5.06, 95% confidence interval (CI) = 4.54 - 5.64, P < 0.001) and in-hospital mortality (OR = 7.26, 95% CI = 6.26 - 8.41, P < 0.001). Other independent predictors were identified, but they showed a weaker association with in-hospital mortality than perioperative stroke, including cardiovascular complications (OR = 4.33, CI = 3.93 - 4.77, P < 0.001).

Conclusions: Perioperative stroke is a significant independent risk factor for morbidity and in-hospital mortality following non-cardiovascular, non-neurological surgeries. Patients who developed perioperative stroke had a higher risk of death than perioperative cardiovascular and pulmonary complications.

J Neurol Res. 2021;11(1-2):5-13
doi: https://doi.org/10.14740/jnr653