Stroke Risk Higher After Major Noncardiac Surgery

Though the risk of deaths and heart attack after noncardiac surgery declined, there was an increase in the incidence if ischemic stroke.

Highlights

Following noncardiac surgery, major adverse cardiovascular and cerebrovascular events (MACCE) are the main cause of perioperative morbidity and mortality.
Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery

In a new study, researchers examined the trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery in the U.S.

The major perioperative adverse cardiovascular and cerebrovascular events (MACCE), include heart attack and ischemic stroke.

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‘Improving the perioperative cardiovascular care of patients undergoing noncardiac surgery will help to prevent the associated mortality and morbidity.’

This poses a significant burden on the national health care system, but recent data on trends in perioperative events and outcomes among patients hospitalized for major noncardiac surgery are missing which prompted researchers to examine the same.

The research team was led by Sripal Bangalore, M.D., M.H.A., of the New York University School of Medicine, New York, and the study is published online by JAMA Cardiology.

Perioperative period is the period of time extending from when the patient gets admitted for surgery until the patient gets discharged.

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Examining the Trends

Annually, more than 300 million noncardiac surgeries are performed worldwide and 50 million surgeries are performed in the U.S. Majority of the noncardiac surgeries include vascular, thoracic and transplant surgeries.

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Major perioperative adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of illness and death. These complicate between 1.4% to 3.9% of the surgeries.

For the study, researchers used National Inpatient Sample, to identify patients who underwent major noncardiac surgeries from January 2004 to December 2013.

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There were 10,581,621 hospitalizations during this period. The average patient age was 66 years and more than half od the patients were women, 57%.

Findings

Perioperative MACCE that included death, acute myocardial infarction or heart attack and acute ischemic stroke, occurred in 317,479 hospitalizations (3%). This corresponded to an annual incidence of approximately 150,000 events.

Major adverse cardiovascular and cerebrovascular events occurred most frequently in patients undergoing:

vascular at 7.7%,
thoracic at 6.5%
transplant surgery at 6.3%

The frequency of perioperative cardiovascular events declined from 3.1% to 2.6 % between 2004 and 2014, but there was an increase in perioperative ischemic stroke from 0.52% in 2004 to 0.77% in 2013.

The risk of perioperative MACCE was higher in men, compared to women. Non-Hispanic black patients had the highest rates of perioperative death and ischemic stroke in comparison to other racial groups.

"Perioperative MACCE occurs in 1 of every 33 hospitalizations for noncardiac surgery," the authors write.

Despite improvements in perioperative outcomes over the past decade, cardiovascular complications and cerebrovascular events remain a major source of mortality and morbidity after non cardiac surgery.

The significant increase in the rate of ischemic stroke in this analysis requires confirmation and further study.

References

Cardiac Risk of Noncardiac Surgery - (http://www.onlinejacc.org/content/66/19/2140)
Sripal Bangalore et al, Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery, JAMA Cardiology; (2016)doi:10.1001/jamacardio.2016.4792

Source-Medindia