Department of Anesthesiology, University of Michigan Medical School, 1H247 UH/Box 5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA.
Anesth Analg. 2013 Feb;116(2):424-34. doi: 10.1213/ANE.0b013e31826a1a32. Epub 2012 Oct 31.
Perioperative stroke is a potentially catastrophic complication of surgery. Patients undergoing vascular surgery suffer from systemic atherosclerosis and are expected to be at increased risk for this complication. We studied the incidence, predictors, and outcomes of perioperative stroke after noncarotid major vascular surgery using the American College of Surgeons National Quality Improvement Program database.
Forty-seven thousand seven hundred fifty patients undergoing noncarotid vascular surgery from 2005 to 2009 at nonVeterans Administration hospitals were identified from the American College of Surgeons National Quality Improvement Program database. An analysis of patients undergoing elective lower extremity amputation, lower extremity revascularization, or open aortic procedures was performed to determine the incidence, independent predictors, and 30-day mortality of perioperative stroke.
The overall incidence of perioperative stroke within 30 days of surgery (n=37,927) was 0.6%. Multivariate analysis revealed that each 1-year increase in age [odds ratio 1.02, 95% confidence interval (CI) (1.01 to 1.04)], cardiac history [1.42, (1.07 to 1.87)], female sex [1.47, (1.12 to 1.93)], history of cerebrovascular disease [1.72, (1.29 to 2.29)], and acute renal failure or dialysis dependence [2.03, (1.39 to 2.97)] were independent predictors of stroke. Only 15% (95% CI, 11%-20%) of strokes occurred on postoperative day 0 or 1. Perioperative stroke was associated with a 3-fold increase in 30-day all-cause mortality [3.36, (1.77 to 6.36)] and an increased median surgical length of stay from 6 (95% CI, 2 to 28) to 13 (95% CI, 3 to 43) days (P<0.001, WMWodds 2.5, 95% CI, 2.0 to 3.2) in a matched-cohort assessment.
Perioperative stroke is an important source of morbidity and mortality, as reflected by significant increases in median surgical length of stay and all-cause 30-day mortality. The independent predictors of stroke that we have identified in this population are not readily modifiable and the majority of strokes occurred after postoperative day 1. Additional studies are required to identify potentially modifiable intraoperative or postoperative risk factors of perioperative stroke.
围手术期卒中是手术的一种潜在灾难性并发症。接受血管手术的患者患有全身性动脉粥样硬化，预计会增加发生这种并发症的风险。我们使用美国外科医师学会国家质量改进计划数据库研究了非颈动脉大血管手术后围手术期卒中的发生率、预测因素和结果。
从美国外科医师学会国家质量改进计划数据库中确定了 2005 年至 2009 年在非退伍军人事务医院接受非颈动脉血管手术的 47750 名患者。对接受选择性下肢截肢术、下肢血运重建术或开放性主动脉手术的患者进行分析，以确定围手术期卒中的发生率、独立预测因素和 30 天死亡率。
手术 30 天内围手术期卒中的总发生率（n=37927）为 0.6%。多变量分析显示，年龄每增加 1 岁[比值比 1.02，95%置信区间（CI）（1.01 至 1.04）]、心脏病史[1.42，（1.07 至 1.87）]、女性[1.47，（1.12 至 1.93）]、脑血管疾病史[1.72，（1.29 至 2.29）]和急性肾功能衰竭或透析依赖[2.03，（1.39 至 2.97）]是卒中的独立预测因素。只有 15%（95%CI，11%-20%）的卒中发生在术后第 0 天或第 1 天。围手术期卒中与 30 天全因死亡率增加 3 倍相关[3.36，（1.77 至 6.36）]，并导致中位手术住院时间从 6 天（95%CI，2 天至 28 天）延长至 13 天（95%CI，3 天至 43 天）（P<0.001，WMWodds 2.5，95%CI，2.0 至 3.2）在匹配队列评估中。
围手术期卒中是发病率和死亡率的一个重要来源，这反映在中位手术住院时间和 30 天全因死亡率的显著增加。我们在该人群中确定的卒中的独立预测因素不易改变，大多数卒中发生在术后第 1 天之后。需要进一步研究以确定围手术期卒中的潜在可改变的术中或术后危险因素。
