Retrospective Analysis Of The Risk Factors For Non-Cardiothoracic And Non-Neurological Surgeries Patients With Perioperative Stroke

Objectives:To discuss the related risk factors and pathogenesis of perioperative stroke in patients of non-cardiothoracic and non-neurological surgeries, thereby providing basis for the prevention and reduction of perioperative stroke.Methods:Patients of non-cardiothoracic and non-neurological surgeries which hospitalized in West Hospital of The First Affiliated Hospital of Guangxi Medical University Hospital from June 1,2012 to October 31,2014 were selected. Case-control study was used to screen the patients featuring neurofunction deficits of hemiplegia, aphasia and disturbance of consciousness in perioperative period, which were diagnosed to be with stroke using head CT scan or MRI and admitted into the case group, while the patient cases without perioperative stroke in the same period, division and types of surgery by a contrast ratio of 1:4 were selected as the control group. The general information, past medical history, personal history, ASA classification, the latest pre-operative laboratory examination results, intraoperative and postoperative situations, whether PCA is used, occurring time of stroke, the site, clinical manifestation, patient discharge and so on were collected for analysis. Furthermore, the risk factors of perioperative stroke in patients of non-cardiothoracic and non-neurological surgeries were also analyzed with Logistic regression model.Results:1.Among the 64,748 cases of non-cardiothoracic and non-neurological surgeries, there were 23 cases (0.035%) of perioperative stroke, all of which were ischemic stroke,including 13 male cases and 10 female cases aging from 35 to 85 years old.2.For the time of stroke occurrence,4 cases were in surgery or 24 h after surgery, 11 cases were in-3 days after surgery,6 cases were in 4-7 days after surgery,1 case was in 8th day after surgery and 1 case was in 15th day after surgery.3.Surgery-related factors and anesthesia-related factors in case group:There were 7 cases of urinary system surgery (30.4%),6 cases of orthopedic surgery (26.1%),4 cases of general surgery (17.4%),3 cases of otolaryngologic surgery (13.0%),2 cases of orthopedic surgery (8.7%) as well as one case of vascular surgery (4.4%), among which there were 17 cases of general anesthesia (73.9%) and 6 cases of epidural anesthesia (26.1%).4.Preoperative risk factors and independent risk factors of perioperative stroke in the patients:23 patients in the case group appeared with one or more risk factors of stroke such as hypertension, diabetes, history of stroke, atrial fibrillation, etc.Results of Logistic regression analysis:The intraoperative hypotension, low INR and high ASA classification are independent risk factors for perioperative stroke.5.Situation during discharge:healing in 11 cases (47.8%), improvement in 8 cases (34.8%), no improvement in 3 cases (13.0%) and 1 case inConclusion:1. The intraoperative hypotension and high ASA classification are independent risk factors for perioperative stroke; 2. The risk factors of stroke, operation and anesthesia related factors may play the vital role in the occurrence of perioperative stroke of non-cardiothoracic and non-neurological surgeries.