Key result
Traditional risk factors, hypotension, and bleeding are linked to increased perioperative stroke risk during non-cardiac surgery.
Why the study?
Perioperative stroke and covert brain infarctions after non-cardiac surgery cause substantial mortality and disability, requiring clinician awareness of evidence on prevention strategies to improve outcomes.
Awareness of traditional risk factors and perioperative events is crucial for preventing perioperative stroke and improving outcomes in non-cardiac surgery.
Supports perioperative stroke risk awareness in non-cardiac surgery; hypothesis-generating for prevention trials.
About 300 million adults undergo non-cardiac surgery annually. Although, in this setting, the incidence of perioperative stroke is low, the absolute number of patients experiencing a stroke is substantial. Furthermore, most patients with this complication will die or end up with severe disability. Covert brain infarctions are more frequent than overt strokes and are associated with postoperative delirium, cognitive decline, and cerebrovascular events at 1 year after surgery. Evidence shows that traditional stroke risk factors including older age, hypertension, and atrial fibrillation are also associated with perioperative stroke; previous stroke is the strongest risk factor for perioperative stroke. Increasing evidence also suggests the pathogenic role of perioperative events, such as hypotension, new atrial fibrillation, paradoxical embolism, and bleeding. Clinicians involved in perioperative care should be aware of this evidence on prevention strategies to improve patient outcomes after non-cardiac surgery.
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Marcucci et al. (2023) conducted a review in Perioperative stroke in non-cardiac surgery. Traditional stroke risk factors and perioperative events such as hypotension and bleeding are associated with an increased risk of perioperative stroke during non-cardiac surgery.
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