Shah Shreyansh, Hatfield Jordan, Fuller Matthew, Ohnuma Tetsu, Luke James Michael, Bartz Raquel R, Raghunathan Karthik, Komisarow Jordan, Krishnamoorthy Vijay
Departments of Neurology, Duke University Medical Center, Durham, NC 27710, United States.
Duke University School, of Medicine, Durham, NC 27710, United States.
J Clin Neurosci. 2022 Jul;101:100-105. doi: 10.1016/j.jocn.2022.05.009. Epub 2022 May 13.
Perioperative ischemic stroke significantly increases morbidity and mortality in patients undergoing elective surgery. Mechanical thrombectomy can improve ischemic stroke outcomes, but frequency and trend of its utilization for treatment of perioperative ischemic stroke is not studied. We identified adults who underwent elective inpatient surgery from 2008 to 2018 and suffered from a perioperative ischemic stroke from the Premier Healthcare Database. The difference in mechanical thrombectomy usage before and after the updated recommendation inacute stroke guidelines was assessed in a univariate analysis using a chi-squared test. A segmented regression model was created to assess the change in rate over time.Of 6,349,668 patients with elective inpatient surgery, 12,507 (0.2%) had perioperative ischemic stroke. Mean age (and standard deviation) was 69.5 (11.7) years, and 48.8% were female. Mechanical thrombectomy was used in 1.7% patients and its use increased from 0.0% in 3rd quarter, 2008 to 4.4% in 4th quarter, 2018. Significant increase in the use of mechanical thrombectomy was seen after 3rd quarter, 2015 when its use was incorporated in acute stroke treatment guideline (1.14% before 3rd quarter, 2015 versus 3.07% after; p < 0.0001). Amongst patients with perioperative ischemic stroke, patients who received mechanical thrombectomy were more likely to have their surgery performed at a teaching institute (67.3% versus 53.9%). Although a significant increase in rates of utilization of mechanical thrombectomy was observed, rates of utilization remain low, especially in non-teaching hospitals. This highlights improvements in the management of perioperative ischemic strokes and further opportunities to improve outcomes.
围手术期缺血性卒中显著增加了接受择期手术患者的发病率和死亡率。机械取栓术可改善缺血性卒中的预后，但尚未对其用于治疗围手术期缺血性卒中的频率和趋势进行研究。我们从Premier医疗数据库中识别出2008年至2018年接受择期住院手术并发生围手术期缺血性卒中的成年人。使用卡方检验在单变量分析中评估急性卒中指南更新推荐前后机械取栓术使用情况的差异。创建了一个分段回归模型来评估随时间的使用率变化。在6349668例接受择期住院手术的患者中，12507例（0.2%）发生了围手术期缺血性卒中。平均年龄（及标准差）为69.5（11.7）岁，48.8%为女性。1.7%的患者使用了机械取栓术，其使用率从2008年第三季度的0.0%增加到2018年第四季度的4.4%。2015年第三季度后，当机械取栓术被纳入急性卒中治疗指南时，其使用率显著增加（2015年第三季度前为1.14%，之后为3.07%；p<0.0001）。在围手术期缺血性卒中患者中，接受机械取栓术的患者更有可能在教学机构接受手术（67.3%对53.9%）。尽管观察到机械取栓术的使用率显著增加，但使用率仍然较低，尤其是在非教学医院。这突出了围手术期缺血性卒中管理方面的改善以及进一步改善预后的机会。
