Factors associated with adverse outcomes following perioperative stroke after noncardiac surgery

BACKGROUND: Perioperative stroke is associated with high rates of adverse outcomes. Our objective was to identify factors associated with 30-day mortality, adverse discharge, and length of hospital stay following perioperative stroke among noncardiac surgical patients, and to analyze trends in these outcomes from 2005 to 2020. STUDY DESIGN: A retrospective cohort study of noncardiac perioperative stroke patients was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2020). Data included patient demographics, comorbidities, stroke, and surgical variables. Elastic net penalization identified variables associated with 30-day mortality (primary outcome), adverse discharge (death or non-home facility) and length of hospital stay in multivariable models. RESULTS: We identified 14,386 patients with perioperative stroke. Strokes occurred a median [interquartile range] of 5 days [2 days to 12 days] after surgery, 24.6 % (N = 3,540) of patients died, and 39.8 % (N = 4,773) were discharged to a non-home facility. Factors significantly associated with 30-day mortality included age, body mass index, postoperative complications, stroke closer to surgery and perioperative blood transfusion (c-statistic = 0.749, 95 % CI 0.739 to 0.758). We did not identify significant changes in mortality and adverse discharge over the study period. CONCLUSION: Several factors were significantly associated with increased risk of poor outcome following perioperative stroke, including potentially modifiable factors such as perioperative anemia, and transfusion. Further research is warranted to identify mechanisms and possible interventions to improve outcome in this population.