J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://www.neurores.org

Original Article

Volume 11, Number 1-2, April 2021, pages 5-13

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

Figure 1. The incidence of perioperative complication and its corresponding in-hospital mortality. GI: gastrointestinal.

Figure 2. (a) The factors’ impact on in-hospital mortality demonstrated by odds ratio and 95% confidence intervals. (b) The impact of perioperative stroke on morbidity, mortality, cardiovascular, respiratory, infection, wound, renal and gastrointestinal complications demonstrated by odds ratio and 95% confidence intervals. LOS: length of stay.

**Table 1.** Patients Characteristics
Characteristic	Subjects without stroke (n, %)	Subjects with stroke (n, %)	Total (n, %)
SD: standard deviation; VWR: van Walraven score.
Perioperative stroke	1,204,318 (99.86%)	1,739 (0.14)	1,206,057 (100)
Age (mean ± SD)	57.88 (19.02)	74.31 (13.83)	57.9 ± 19.02
Age
Under 65	712,080 (99.90)	364 (0.10)	712,444 (59.7)
65 - 74	222,312 (99. 80)	375 (0.20)	222,687 (18.7)
75 - 84	176,721 (99.70)	543 (0.30)	177,264 (14.9)
85+	806,90 (99.40)	457 (0.60)	81,147 (6.8)
Gender
Male	422,847 (99.8)	716 (0.2)	423,563 (36.6)
Female	731,966 (99.9)	1,021 (0.1)	732,987 (63.4)
Race
White	729,786 (99.80)	1,172 (0.20)	730,958 (60.6)
Black	60,134 (99.84)	97 (0.16)	60,231 (5.5)
Hispanic	223,043 (99.90)	254 (0.10)	223,297 (18.5)
Asian or pacific islander	57,703 (99.79)	124 (0.21)	57,827 (4.8)
Native American	861 (99.80)	2 (0.20)	863 (0.1)
Other	17,872 (99.83)	31 (0.17)	17,903 (1.5)
Procedure
Hemicolectomy	37,350 (99.95)	189 (0.5)	37,539 (3.1)
Appendectomy	125,299 (99.98)	27 (0.02)	125,326 (10.4)
Cholecystectomy	162,540 (99.91)	145 (0.09)	162,685 (13.5)
Hip replacement	154,976 (99.98)	338 (0.2)	155,314 (12.9)
Knee replacement	210,253 (99.92)	169 (0.08)	210,422 (17.4)
Treatment of fracture or dislocation of lower extremity	92,217 (99.59)	382 (0.41)	92,599 (7.7)
Amputation of lower extremity	37,654 (99.56)	167 (0.44)	37,821 (3.1)
Laminectomy	172,324 (99.89)	90 (0.11)	81,089 (6.7)
Spine fusion	130,768 (99.86)	192 (0.14)	130,960 (10.9)
Hysterectomy	172,324 (99.98)	40 (0.02)	172,364 (14.3)
Admission type
Emergency	408,149 (99.75)	1,013 (0.25)	409,162 (33.9)
Elective/other	796,169 (99.91)	726 (0.09)	796,895 (66.1)
Van Walraven score category
Low risk (VWR < 5)	989,888 (99.96)	436 (0.04)	990,324 (82.1)
Intermediate risk (VWR 5 - 14)	180, 824 (99.56)	792 (0.44)	181,616 (15.1)
High risk (VWR > 14)	33,668 (98.50)	511 (1.50)	34,179 (2.8)
Length of stay, mean	16.04 (17.18)	4.02 (5.14)	4.04 (5.21)
In-hospital mortality	6,481 (94.03)	329 (5.07)	6,810 (0.56)
Morbidity	97,186 (99.1)	920 (0.9)	98,106 (8.1)

Table 1. Patients Characteristics

Characteristic

Subjects without stroke (n, %)

Subjects with stroke (n, %)

Total (n, %)

SD: standard deviation; VWR: van Walraven score.

Perioperative stroke

1,204,318 (99.86%)

1,739 (0.14)

1,206,057 (100)

Age (mean ± SD)

57.88 (19.02)

74.31 (13.83)

57.9 ± 19.02

Age

Under 65

712,080 (99.90)

364 (0.10)

712,444 (59.7)

65 - 74

222,312 (99. 80)

375 (0.20)

222,687 (18.7)

75 - 84

176,721 (99.70)

543 (0.30)

177,264 (14.9)

85+

806,90 (99.40)

457 (0.60)

81,147 (6.8)

Gender

Male

422,847 (99.8)

716 (0.2)

423,563 (36.6)

Female

731,966 (99.9)

1,021 (0.1)

732,987 (63.4)

Race

White

729,786 (99.80)

1,172 (0.20)

730,958 (60.6)

Black

60,134 (99.84)

97 (0.16)

60,231 (5.5)

Hispanic

223,043 (99.90)

254 (0.10)

223,297 (18.5)

Asian or pacific islander

57,703 (99.79)

124 (0.21)

57,827 (4.8)

Native American

861 (99.80)

2 (0.20)

863 (0.1)

Other

17,872 (99.83)

31 (0.17)

17,903 (1.5)

Procedure

Hemicolectomy

37,350 (99.95)

189 (0.5)

37,539 (3.1)

Appendectomy

125,299 (99.98)

27 (0.02)

125,326 (10.4)

Cholecystectomy

162,540 (99.91)

145 (0.09)

162,685 (13.5)

Hip replacement

154,976 (99.98)

338 (0.2)

155,314 (12.9)

Knee replacement

210,253 (99.92)

169 (0.08)

210,422 (17.4)

Treatment of fracture or dislocation of lower extremity

92,217 (99.59)

382 (0.41)

92,599 (7.7)

Amputation of lower extremity

37,654 (99.56)

167 (0.44)

37,821 (3.1)

Laminectomy

172,324 (99.89)

90 (0.11)

81,089 (6.7)

Spine fusion

130,768 (99.86)

192 (0.14)

130,960 (10.9)

Hysterectomy

172,324 (99.98)

40 (0.02)

172,364 (14.3)

Admission type

Emergency

408,149 (99.75)

1,013 (0.25)

409,162 (33.9)

Elective/other

796,169 (99.91)

726 (0.09)

796,895 (66.1)

Van Walraven score category

Low risk (VWR < 5)

989,888 (99.96)

436 (0.04)

990,324 (82.1)

Intermediate risk (VWR 5 - 14)

180, 824 (99.56)

792 (0.44)

181,616 (15.1)

High risk (VWR > 14)

33,668 (98.50)

511 (1.50)

34,179 (2.8)

Length of stay, mean

16.04 (17.18)

4.02 (5.14)

4.04 (5.21)

In-hospital mortality

6,481 (94.03)

329 (5.07)

6,810 (0.56)

Morbidity

97,186 (99.1)

920 (0.9)

98,106 (8.1)

**Table 2.** Multivariable Regression Model 1: Morbidity and Mortality
Characteristic	Morbidity	Mortality
OR: odds ratio; CI: confidence interval; REF: reference.
Age groups
Under 65	REF	-	REF	-
65 - 74	1.40 (1.37, 1.43)	< 0.001	1.56 (1.43, 1.69)	< 0.001
75 - 84	1.60 (1.57, 1.64)	< 0.001	2.12 (1.96, 2.29)	< 0.001
85+	1.67 (1.63, 1.72)	< 0.001	3.30 (3.04, 3.58)	< 0.001
Gender
Male	REF	-	REF	-
Female	0.82 (0.81, 0.83)	< 0.001	0.76 (0.72, 0.80)	< 0.001
Race
White	REF	< 0.001	REF	-
Black	1.26 (1.22, 1.30)	< 0.001	1.07 (0.96, 1.19)	0.180
Hispanic	0.96 (0.94, 0.98)	< 0.001	1.02 (0.95, 1.10)	0.467
Asian or Pacific Islander	1.15 (1.11, 1.18)	< 0.001	0.99 (0.89, 1.10)	0.875
Native American	1.18 (0.93, 1.49)	0.158	0.35 (0.08, 1.43)	0.145
Others	1.11 (1.05, 1.17)	< 0.001	1.13 (0.93, 1.37)	0.198
Procedure
Hemicolectomy	REF	-	REF	-
Appendectomy	0.17 (0.16, 0.17)	< 0.001	0.11 (0.09, 0.14)	< 0.001
Cholecystectomy	0.16 (0.15, 0.16)	< 0.001	0.27 (0.24, 0.30)
Hip replacement	0.12 (0.12, 0.13)	< 0.001	0.30 (0.27, 0.33)	< 0.001
Knee replacement	0.11 (0.11, 0.12)	< 0.001	0.13 (0.11, 0.16)	< 0.001
Treatment of fracture of lower extremity	0.11 (0.11, 0.12)	< 0.001	0.34 (0.31, 0.37)	< 0.001
Amputation of lower extremity	0.39 (0.38, 0.43)	< 0.001	0.81 (0.74, 0.90)	< 0.001
Laminectomy	0.16 (0.15, 0.16)	< 0.001	0.36 (0.31, 0.42)	< 0.001
Spine fusion	0.33 (0.32, 0.34)	< 0.001	0.36 (0.31, 0.37)	< 0.001
Hysterectomy	0.22 (0.21, 0.23)	< 0.001	0.23 (0.19, 0.29)	< 0.001
Admission type
Elective	REF	-	REF	-
Emergency	2.15 (2.11, 2.20)	< 0.001	2.98 (2.77, 3.22)	< 0.001
Van Walraven groups
< 5	REF	-	REF	-
5 - 14	2.52 (2.48, 2.56)	< 0.001	4.62 (4.28, 4.98)	< 0.001
> 14	5.60 (5.45, 5.76)	< 0.001	13.09 (12.08, 14.19)	< 0.001
Perioperative stroke	5.06 (4.54, 5.64)	< 0.001	7.26 (6.26, 8.41)	< 0.001
Cardiovascular complications	-	-	4.33 (3.93, 4.77)	< 0.001
Pulmonary complications	-	-	4.76 (4.40, 5.14)	< 0.001
Gastrointestinal complications	-	-	1.56 (1.43, 1.69)	< 0.001
Post-operative infection	-	-	1.79 (1.64, 1.95)	< 0.001
Wound complications	-	-	1.45 (1.27, 1.66)	< 0.001
Renal complications	-	-	1.12 (0.90, 1.40)	0.294

Table 2. Multivariable Regression Model 1: Morbidity and Mortality

Characteristic

Morbidity

Mortality

OR (95% CI)

P value

OR (95% CI)

P value

OR: odds ratio; CI: confidence interval; REF: reference.

Age groups

Under 65

REF

65 - 74

1.40 (1.37, 1.43)

< 0.001

1.56 (1.43, 1.69)

< 0.001

75 - 84

1.60 (1.57, 1.64)

< 0.001

2.12 (1.96, 2.29)

< 0.001

85+

1.67 (1.63, 1.72)

< 0.001

3.30 (3.04, 3.58)

< 0.001

Gender

Male

REF

Female

0.82 (0.81, 0.83)

< 0.001

0.76 (0.72, 0.80)

< 0.001

Race

White

REF

< 0.001

REF

Black

1.26 (1.22, 1.30)

< 0.001

1.07 (0.96, 1.19)

0.180

Hispanic

0.96 (0.94, 0.98)

< 0.001

1.02 (0.95, 1.10)

0.467

Asian or Pacific Islander

1.15 (1.11, 1.18)

< 0.001

0.99 (0.89, 1.10)

0.875

Native American

1.18 (0.93, 1.49)

0.158

0.35 (0.08, 1.43)

0.145

Others

1.11 (1.05, 1.17)

< 0.001

1.13 (0.93, 1.37)

0.198

Procedure

Hemicolectomy

REF

Appendectomy

0.17 (0.16, 0.17)

< 0.001

0.11 (0.09, 0.14)

< 0.001

Cholecystectomy

0.16 (0.15, 0.16)

< 0.001

0.27 (0.24, 0.30)

Hip replacement

0.12 (0.12, 0.13)

< 0.001

0.30 (0.27, 0.33)

< 0.001

Knee replacement

0.11 (0.11, 0.12)

< 0.001

0.13 (0.11, 0.16)

< 0.001

Treatment of fracture of lower extremity

0.11 (0.11, 0.12)

< 0.001

0.34 (0.31, 0.37)

< 0.001

Amputation of lower extremity

0.39 (0.38, 0.43)

< 0.001

0.81 (0.74, 0.90)

< 0.001

Laminectomy

0.16 (0.15, 0.16)

< 0.001

0.36 (0.31, 0.42)

< 0.001

Spine fusion

0.33 (0.32, 0.34)

< 0.001

0.36 (0.31, 0.37)

< 0.001

Hysterectomy

0.22 (0.21, 0.23)

< 0.001

0.23 (0.19, 0.29)

< 0.001

Admission type

Elective

REF

Emergency

2.15 (2.11, 2.20)

< 0.001

2.98 (2.77, 3.22)

< 0.001

Van Walraven groups

< 5

REF

5 - 14

2.52 (2.48, 2.56)

< 0.001

4.62 (4.28, 4.98)

< 0.001

> 14

5.60 (5.45, 5.76)

< 0.001

13.09 (12.08, 14.19)

< 0.001

Perioperative stroke

5.06 (4.54, 5.64)

< 0.001

7.26 (6.26, 8.41)

< 0.001

Cardiovascular complications

4.33 (3.93, 4.77)

< 0.001

Pulmonary complications

4.76 (4.40, 5.14)

< 0.001

Gastrointestinal complications

1.56 (1.43, 1.69)

< 0.001

Post-operative infection

1.79 (1.64, 1.95)

< 0.001

Wound complications

1.45 (1.27, 1.66)

< 0.001

Renal complications

1.12 (0.90, 1.40)

0.294