Surgical patients at increased risk up to 9 months post-stroke

Stroke patients may be at a greater risk for post-surgical complications, particularly when they had a stroke less than three months prior to surgery, according to a study published July 16 in JAMA.

A Danish team found that patients who had a stroke less than three months prior to surgery had an 149.6-fold higher incidence of 30-day ischemic stroke and 12.6-fold higher incidence of all-cause mortality compared with patients who had no prior stroke.

Utilizing the Danish National Registry data from 2005 through 2011, the research team led by Mads E. Jørgensen, MB, of University of Copenhagen’s Gentofte Hospital, tracked outcomes for 481,183 elective surgeries. Of those surgeries, 1.5 percent occurred to patients with a history of stroke.

When the outcomes were stratified by patients who had no history of stroke, patients who had a stroke up to three months prior, patients who had a stroke six months prior, patients who had a stroke less than 12 months prior and patients whose strokes had occurred 12 months or more prior, complication risks leveled off at around nine months following an initial stroke. These patients were by no means out of the woods, however. 

Prior ischemic stroke, Jørgensen et al noted, was still associated with a 1.8-fold increased risk of 30-day mortality and 4.8-fold increase in risk of 30-day major adverse cardiac events (MACE) compared with patients with no history of stroke irrespective of time between stroke and surgery. 

The group who bore the highest risk for 30-day ischemic stroke (odds ratio 67.6), mortality (3.07) or MACE (14.03) was the one that had a stroke less than three months prior. Odds were markedly different for the less than six months group, ischemic stroke, mortality and MACE being 24.02, 1.97 and 4.85, respectively. At six to 12 months post-stroke, odds of 30-day stroke, mortality and MACE were 10.39, 1.45 and 3.04, respectively, while 12 months or more post-stroke odds were 8.17, 1.46 and 2.47, respectively.

Jørgensen et al recommended physician consideration of time post-stroke and potential risks when discussing surgical options with patients.