Development and Validation of a Prediction Model for Stroke, Cardiac, and Mortality Risk After Non‐Cardiac Surgery

Abstract

Background Commonly used cardiovascular risk calculators do not provide risk estimation of stroke, a major postoperative complication with high morbidity and mortality. We developed and validated an accurate cardiovascular risk prediction tool for stroke, major cardiac complications (myocardial infarction or cardiac arrest), and mortality after non‐cardiac surgery. Methods and Results This retrospective cohort study included 1 165 750 surgical patients over a 4‐year period (2007–2010) from the American College of Surgeons National Surgical Quality Improvement Program Database. A predictive model was developed with the following preoperative conditions: age, history of coronary artery disease, history of stroke, emergency surgery, preoperative serum sodium (≤130 mEq/L, >146 mEq/L), creatinine >1.8 mg/dL, hematocrit ≤27%, American Society of Anesthesiologists physical status class, and type of surgery. The model was trained using American College of Surgeons National Surgical Quality Improvement Program data from 2007 to 2009 (n=809 880) and tested using data from 2010 (n=355 870). Risk models were developed using multivariate logistic regression. The outcomes were postoperative 30‐day stroke, major cardiovascular events (myocardial infarction, cardiac arrest, or stroke), and 30‐day mortality. Major cardiac complications occurred in 0.66% (n=5332) of patients (myocardial infarction, 0.28%; cardiac arrest, 0.41%), postoperative stroke in 0.25% (n=2005); 30‐day mortality was 1.66% (n=13 484). The risk prediction model had high predictive accuracy with area under the receiver operating characteristic curve for stroke (training cohort=0.869, validation cohort=0.876), major cardiovascular events (training cohort=0.871, validation cohort=0.868), and 30‐day mortality (training cohort=0.922, validation cohort=0.925). Surgery types, history of stroke, and coronary artery disease are significant risk factors for stroke and major cardiac complications. Conclusions Postoperative stroke, major cardiac complications, and 30‐day mortality can be predicted with high accuracy using this web‐based predictive model.

Systemic-Immune-Inflammation Index as a Promising Biomarker for Predicting Perioperative Ischemic Stroke in Older Patients Who Underwent Non-cardiac Surgery

“…Of the entire patient cohort, 237 (0.58%) experienced an ischemic stroke within 30 days after surgery. The stroke incidence was consistent with previously reported rates of 0.1–0.7% in patients who underwent non-cardiac surgery ( Vasivej et al, 2016 ; Woo et al, 2021 ).…”

Type 2 Diabetes Increases Risk of Unfavorable Survival Outcome for Postoperative Ischemic Stroke in Patients Who Underwent Non-cardiac Surgery: A Retrospective Cohort Study

“…In the PeriOpearative Ischemic Evaluation (POISE) trial of 8,351 patients who underwent non-cardiac surgery, 60 (0.7%) patients developed stroke within 30 days after surgery ( POISE Study Group et al, 2008 ). A recent retrospective cohort study, such as 1,165,750 surgical patients, suggests that postoperative ischemic stroke was found in 2,500 patients (0.25%) ( Woo et al, 2021 ). In the current study, 484 patients with postoperative ischemic stroke were found in a large cohort of 2,21,541 patients with non-cardiac surgery.…”

Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View

“…There is even less data here. For example, the lifetime risk of ESRD after LDN in a 70-year-old man is 0.15% (95% CI 0.05, 0.28), and the relative risk for ESRD from non-insulin dependent diabetes is 3.01 (1.91, 4.74)- the absolute risk would appear to be low, but we have no data on the effect of donation on subsequent ESRD in this scenario ( 22 ).…”