Key result
Pre-existing cerebrovascular disease was associated with a non-significant increase in intraoperative cerebral desaturation events compared to matched controls (29% vs 8.3%, RR 3.5, p=0.094).
Why the study?
Stroke is a devastating perioperative complication lacking effective methods for prevention or diagnosis, prompting analysis of strategies to detect cerebrovascular vulnerability and injury in high-risk non-cardiac surgery patients.
Does known cerebrovascular disease increase perioperative neurologic vulnerability measured by cerebral oximetry and biomarkers in patients undergoing non-cardiac surgery?
Cohort (n=50)
No
Does known cerebrovascular disease increase perioperative neurologic vulnerability measured by cerebral oximetry and biomarkers in patients undergoing non-cardiac surgery?
Relative Risk: 3.5 (95% CI 0.81–15.2)
Absolute Event Rate: 29% vs 8.3%
p-value: p=0.094
In patients undergoing non-cardiac surgery, known cerebrovascular disease did not result in statistically significant differences in cerebral oximetry, cognitive trajectory, or molecular biomarkers compared to controls.
No clear perioperative markers distinguished high-risk patients; leaves open need for validated tools to detect cerebrovascular vulnerability.
Background: Stroke is a devastating perioperative complication without effective methods for prevention or diagnosis. The objective of this study was to analyze evidence-based strategies for detecting cerebrovascular vulnerability and injury in a high-risk cohort of non-cardiac surgery patients. Methods: This was a single-center, prospective cohort study. Fifty patients undergoing non-cardiac surgery were recruited – 25 with known cerebrovascular disease and 25 matched controls. Neurologic vulnerability was measured with intraoperative cerebral oximetry as the primary outcome. Perioperative neurocognitive testing and serum biomarker analysis (S-100β, neuron specific enolase, glial fibrillary acid protein, and matrix metalloproteinase-9) were measured as secondary outcomes. Results: Cerebral desaturation events (an oximetry decrease ≥20% from baseline or <50% absolute value for ≥3 minutes) occurred in 7/24 (29%) cerebrovascular disease patients and 2/24 (8.3%) controls (relative risk 3.5, 95% CI 0.81–15.2; P=0.094). Cognitive function trends were similar in both groups, though overall scores (range: 1500 – 7197) were approximately one standard deviation lower in cerebrovascular patients across the entire perioperative period (-1049 [95% CI -1662, -436], P<0.001). No significant serum biomarker differences were found between groups over time. One control patient experienced intraoperative hypoxic-ischemic injury, but no robust biomarker or oximetry changes were observed. Conclusions: Cerebrovascular disease patients did not demonstrate dramatic differences in cerebral oximetry, cognitive trajectory, or molecular biomarkers compared to controls. Moreover, a catastrophic hypoxic-ischemic event was neither predicted nor detected by any strategy tested. These findings support the need for novel research into cerebrovascular risk and vulnerability.
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Vlisides et al. (2019) conducted a cohort in Cerebrovascular disease (n=50). Pre-existing cerebrovascular disease vs. Matched controls without cerebrovascular disease was evaluated on Sustained (≥3 min) intraoperative cerebral desaturation (≥20% relative decrease from baseline or absolute value <50%) (RR 3.5, 95% CI 0.81-15.2, p=0.094). Pre-existing cerebrovascular disease was associated with a non-significant increase in intraoperative cerebral desaturation events compared to matched controls (29% vs 8.3%, RR 3.5, p=0.094).
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