Delay or not to delay elective nonneurologic, noncardiac surgery after stroke?
USA: Among older patients undergoing elective non-neurologic, noncardiac surgery, waiting for more than 90 days after a stroke did not reduce the risk of recurrent stroke and death, a recent study has found.
The findings of the study, published in JAMA Surgery, suggest that the recent scientific statement made by the American Heart Association for delaying elective non-neurologic, noncardiac surgery for at least 6 months after a recent stroke may be too conservative.
Perioperative strokes are a root cause of disability and death. There is not much information on which to base decisions on how long to delay elective non-neurologic, noncardiac surgery in patients with stroke history. Considering this, Laurent G. Glance, University of Rochester School of Medicine, Rochester, New York, and colleagues aimed to investigate whether an association exists between the time elapsed since an ischemic stroke and the risk of recurrent stroke in older patients undergoing elective non-neurologic, noncardiac surgery in a cohort study.
The study used data from the 100% Medicare Provider Analysis and Review files, including the Master Beneficiary Summary File, between 2011 and 2018. It included elective non-neurologic, and noncardiac surgeries in patients 66 years or older. If the patients had more than 1 procedure during a 30-day period, were missing information on race and ethnicity, were transferred from another hospital or facility, were admitted in December 2018, or had tracheostomies or gastrostomies, they were excluded. Data analysis was done from May 7 to October 23, 2021.
The main outcome was acute ischemic stroke during the index surgical admission or rehospitalization for stroke within 30 days of surgery, composite of stroke and mortality, 30-day all-cause mortality, and discharge to a nursing home or skilled nursing facility.
Adjusted odds ratios (AORs) were estimated using multivariable logistic regression models to quantify the association between outcome and time since ischemic stroke.
The study led to the following findings:
- The final cohort included 5 841 539 patients who underwent elective non-neurologic, noncardiac surgeries (mean age, 74.1 years; 3 371 329 [57.7%] women), of which 0.9% had a previous stroke.
- Patients with a stroke within 30 days before surgery had higher adjusted odds of perioperative stroke (AOR, 8.02) compared with patients without a previous stroke.
- The adjusted odds of stroke were not significantly different at an interval of 61 to 90 days between previous stroke and surgery (AOR, 5.01) compared with 181 to 360 days (AOR, 4.76).
- The adjusted odds of 30-day all-cause mortality were higher in patients who underwent surgery within 30 days of a previous stroke (AOR, 2.51) compared with those without a history of stroke, and the AOR decreased to 1.49 at 61 to 90 days from the previous stroke to surgery but did not decline significantly, even after an interval of 360 or more days.
The authors concluded by saying that, "findings indicate that the risk of stroke and death leveled off when more than 90 days elapsed between a previous stroke and elective surgery among patients undergoing non-neurologic, noncardiac surgery."
Reference:
Glance LG, Benesch CG, Holloway RG, et al. Association of Time Elapsed Since Ischemic Stroke With Risk of Recurrent Stroke in Older Patients Undergoing Elective Nonneurologic, Noncardiac Surgery. JAMA Surg. Published online June 29, 2022. doi:10.1001/jamasurg.2022.2236
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