Risk factors, clinical features and prognosis of perioperative stroke in adults

Abstract

INTRODUCTION: Perioperative stroke (POS) is an uncommon but severe surgical complication. No widely accepted guidelines for risk prediction or management have been established. Its prevention depends on knowledge about the nature of this disease. METHODS: A total of 36 cases and equal number of controls in Hong Kong West Cluster hospitals were recruited over 43 months. Peri- and intra-operative features were compared and characteristics of POS were described. RESULTS: Atrial fibrillation, diabetes mellitus (DM), and history of stroke were identified as risk factors (P=0.017, 0.002, and 0.003, respectively). Prolonged aortic occlusion (P=0.018) and bypass (P=0.002) contributed in cardiac surgery. Only few BP parameters, but not consistently all, were significant; 78% POS were infarcts. Watershed infarction related to hypotension was uncommon. Beta-blocker use seemed to bare protective effect. Blood loss and haemoglobin levels did not correlate to POS. Three-month mortality rate was 36%. CONCLUSION: Optimal DM control and cardioversion before elective OT, perioperative anticoagulation in AF and old stroke patients, and beta-blockers may be preventive measures for POS. Role of hypotension in POS aetiology is debatable.