Key result
Preoperative stroke up to 5 years prior to major surgery was associated with a significantly increased risk of 1-year mortality (adjusted OR 1.16) compared to patients without prior stroke.
Why the study?
As the population aged over 60 expands, the impact of stroke on perioperative care is of increasing concern, prompting investigation into how preoperative stroke affects short- and long-term outcomes after major surgery.
Does preoperative stroke increase 1-year mortality and reduce days at home alive up to 30 days after major non-cardiovascular surgery in adult patients?
Cohort (n=290,306)
Yes
Does preoperative stroke increase 1-year mortality and reduce days at home alive up to 30 days after major non-cardiovascular surgery in adult patients?
Odds Ratio: 1.16 (95% CI 1.08–1.24)
Absolute Event Rate: 18% vs 6.2%
p-value: p=<0.001
Preoperative stroke within 5 years of major non-cardiovascular surgery is an independent risk factor for increased 1-year mortality and fewer days at home alive within 30 days post-surgery.
Supports preoperative stroke as a prognostic marker in non-cardiac surgery; leaves open whether mitigation strategies improve outcomes.
OBJECTIVE: The lifetime risk of stroke is one in four people. As the population aged over 60 constantly expands, the impact of stroke on perioperative care is of increasing concern. This study investigates the effect of preoperative stroke on short- and long-term outcomes, hypothesizing that it decreases both 1-year mortality and days alive and at home up to 30 days after surgery (DAH30). METHODS: This cohort study investigated 290,306 adult patients with (7214) and without (283,092) preoperative stroke undergoing major non-cardiovascular, non-ambulatory surgery at 23 hospitals in Sweden between 2007 and 2014. Data were pre- and postoperatively matched with quality registers. Using logistic regression, significant independent risk factors influencing the risk of 1-year mortality and impeded DAH30 were identified with adjusted odds ratios calculated. RESULTS: Preoperative stroke was associated with higher 1-year mortality and lower DAH30, even after full adjustment for other co-morbid and surgical factors. CONCLUSIONS: This large cohort showed preoperative stroke to impact both the patient-centered short-term outcome DAH30 and 1-year mortality. These findings should be considered in perioperative planning.
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Widaeus et al. (2024) conducted a cohort in Major non-cardiovascular, non-ambulatory surgery (n=290,306). Preoperative stroke vs. No preoperative stroke was evaluated on 1-year mortality (OR 1.16, 95% CI 1.08-1.24, p=<0.001). Preoperative stroke up to 5 years prior to major surgery was associated with a significantly increased risk of 1-year mortality (adjusted OR 1.16) compared to patients without prior stroke.
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