Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study

Abstract

Background and PurposePerioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI.MethodsA retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision. Univariate and multivariate analyses were performed using patient demographics and comorbidities to identify predictors of mortality and morbidity, defined by a length of stay of >14 days and/or discharge to a place other than home.ResultsData were obtained from 7,556 patients undergoing TAVI during 2012 and 2013. The incidence rates of mortality and morbidity were 4.57 and 71.12%, respectively. Perioperative stroke was an independent risk factor for mortality [odds ratio (OR)=3.182, 95% confidence interval (CI)=1.530–6.618, p=0.002], as were infection (OR=17.899, 95% CI=9.876–32.440, p<0.001) and pericardial tamponade (OR=7.272, 95% CI=2.874–18.402, p<0.001). Stroke also predicted morbidity (OR=5.223, 95% CI=2.005–13.608, p=0.001), which was also associated with age, being female, being Asian, moderate and high Van Walraven scores (VWR), and infection.ConclusionsIn conclusion, perioperative stroke was found to be independently associated with in-hospital mortality and postoperative morbidity, as are age and high VWR. Our findings support the use of further preoperative, intraoperative, and postoperative management strategies during TAVI.

Perioperative stroke-related mortality after non-cardiovascular, non-neurological procedures: A retrospective risk factor evaluation of common surgical comorbidities

“…Our results reveal that atrial fibrillation, diabetes and in-hospital strokes may be independent risk factors for perioperative stroke-related mortality in the non-cardiovascular, non-neurological surgery population. Conditions outlined in the Risk Analysis Index, along with other comorbidities previously identified as common aetiologies for perioperative strokes, were used as guidelines for the scope of this study (Bateman et al 2009, Limburg et al 1998, Mashour et al 2014, Parikh & Cohen 1993, Smilowitz et al 2017, Thirumala et al 2017, Wang et al 2019). Frailty, as measured by the Risk Analysis Index, has well-elucidated associations with perioperative mortality in high-risk surgical patients (Hall et al 2017).…”

“…Perioperative strokes are defined as potentially fatal neurovascular events which occur during or within 30 days of a surgical procedure and are a growing cause of perioperative morbidity, mortality and increased healthcare costs (Caplan & Hennerici 1998, Etzioni et al 2003, Mashour et al 2014, Thirumala et al 2017). While risks of perioperative stroke have been evaluated, the causes of mortality related to perioperative stroke have not yet been elucidated.…”

“…Large vessel occlusions account for only one-third of all acute ischemic strokes, but are responsible for greater than 90% of deaths following an acute ischemic stroke. Atrial fibrillation and asymptomatic carotid stenosis have been indicated as risk factors for large vessel occlusions with large infarct sizes; however, the relationship between large vessel occlusion risk factors and perioperative stroke-related mortality has not yet been established (Al-Mufti et al 2017, Thirumala et al 2017).…”

“…Thus, our ability to sufficiently screen for perioperative stroke-related mortality risk factors is inhibited by the limitations of current knowledge. Furthermore, the Risk Analysis Index and other supporting literature have collectively identified advanced age (>65 y/o), female sex, current or previous malignancy, diabetes, hypertension, renal failure, congestive heart failure, previous myocardial infarction, history of stroke, in-hospital stroke, emergency procedure and admission source as factors that increase the risk of having a perioperative stroke within the non-cardiovascular, non-neurological surgery populations (Bateman et al 2009, Hall et al 2017, Limburg et al 1998, Mashour et al 2014, Parikh & Cohen 1993, Smilowitz et al 2017, Thirumala et al 2017, Wang et al 2019).…”

Risk Factors and Incidence of Acute Ischemic Stroke: A Comparative Study Between Young Adults and Older Adults

“…The secondary interest was to compare outcomes of AIS in YA and OA. The outcomes were all-cause mortality during hospitalization, morbidity (length of stay >10 days {>90th percentile of AIS hospitalization} and discharge to non-home {transfer to short-term hospital, skilled nursing facility, intermediate care facility, or home health care}), discharge disposition (discharge to home vs. non-home), All Patients Refined Diagnosis Related Groups (APR-DRG) risk of mortality, APR-DRG severity of illness (disability), length of stay (LoS), and cost of hospitalization [ 16 ]. APR-DRGs were assigned using software developed by 3M Health Information Systems, where score 1 indicates minor loss of function, 2-moderate, 3-major, 4-extreme loss of function or likelihood of death.…”