Time Elapsed After Ischemic Stroke and Risk of Adverse Cardiovascular Events and Mortality Following Elective Noncardiac Surgery

Abstract

A history of stroke was associated with adverse outcomes following surgery, in particular if time between stroke and surgery was less than 9 months. After 9 months, the associated risk appeared stable yet still increased compared with patients with no stroke. The time dependency of risk may warrant attention in future guidelines.

Preoperative evaluation of adult patients before elective, noncardiothoracic surgery

“…Intraoperative hypotension, including position-dependent hypotension (e. g., when the patient is in a half-sitting position), is recognized as an important predisposing factor [29,30]. Mortality after perioperative insult is twice that after insults occurring outside of the clinic.…”

“…Mortality after perioperative insult is twice that after insults occurring outside of the clinic. Established scores for estimation of the perioperative stroke risk are currently not available [8,29]. The following procedure appears reasonable on the basis of the available literature (.…”

“…3): 4 The perioperative indications for a diagnostic or therapeutic intervention in the region of the carotid artery do not differ from those in patients not facing surgery [30,31]. 4 The interval between a cerebral ischemic attack and elective surgery should be at least 6 months [8,29]. 4 Preoperative sonography of the carotid artery does not seem to reduce the perioperative stroke risk in patients who have been symptom free for the past 6 months and is therefore not recommended.…”

“…Provided justifiable in terms of the bleeding risk, these prophylactic treatments should not be interrupted perioperatively. In this case, patient management-including the indication to delay surgery-follows the treatment concepts for cardiac patients on dual antiplatelet therapy (see chapter C.6) [29,31].…”

Noncardiac Surgery in Patients With Aortic Stenosis: A Contemporary Study on Outcomes in a Matched Sample From the Danish Health Care System

“…All of the registries have previously been used in research. 8,9 In brief, we used the Danish National Patient Registry to identify all patients with AS age ≥20 years who underwent noncardiac surgery between 2005 and 2011. Those with prior replacement surgery or percutaneous valve repair on the aortic valve (Nordic classification system code KFM) were not included.…”