• Mia N Christiansen, Charlotte Andersson, Gunnar H Gislason, Christian Torp-Pedersen, Robert D Sanders, Per Føge Jensen, and Mads E Jørgensen.
• From The Cardiovascular Research Center, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (M.N.C., C.A., G.H.G., M.E.J.); Department of Cardiology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark (C.A.); Department of Health Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); Anesthesiology and Critical Care Trials and Interdisciplinary Outcome Network, Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin (R.D.S.); and The Pain Clinic, Department of Anesthesiology, Næstved Hospital, Næstved, Denmark (P.F.J.).
• Anesthesiology. 2017 Jul 1; 127 (1): 9-19.

BackgroundThe outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown.MethodsAll emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14 days), propensity-score matching was performed.ResultsOf 146,694 nonvascular surgeries (composing 98% of all emergency surgeries), 5.3% had previous stroke (mean age, 75 yr [SD = 13]; 53% women, 50% major orthopedic surgery). Antithrombotic treatment and atrial fibrillation were more frequent and general anesthesia less frequent in patients with previous stroke (all P < 0.001). Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained increased for stroke within 3 to 9 months (10.3 and 12.3%; OR = 1.93 [95% CI, 1.55 to 2.40] and 1.20 [95% CI, 0.98 to 1.47]) and stroke more than 9 months (8.8 and 11.7%; OR = 1.62 [95% CI, 1.43 to 1.84] and 1.20 [95% CI, 1.08 to 1.34]) compared with no previous stroke (2.3 and 4.8% events). Major adverse cardiovascular events were significantly lower in 323 patients undergoing immediate surgery (21%) compared with 323 successfully propensity-matched early surgery patients (29%; P = 0.029).ConclusionsAdverse cardiovascular outcomes and mortality were greatly increased among patients with recent stroke. However, events were higher 4 to 14 days after stroke compared with 1 to 3 days after stroke.

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