• Hong Wang, Shuang-Ling Li, Jing Bai, and Dong-Xin Wang.
• Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China; Intensive Care Unit, First Hospital, Baoding City, Hebei Province, China.
• J. Cardiothorac. Vasc. Anesth. 2019 Aug 1; 33 (8): 2231-2236.

ObjectiveTo identify the predictors of in-hospital mortality in patients who develop perioperative acute ischemic stroke (PAIS) associated with noncardiac, nonvascular, and non-neurologic surgery.DesignRetrospective study.SettingUniversity-affiliated hospital.ParticipantsThe study comprised 100 patients with PAIS.InterventionsNone.Measurements And Main ResultsThe data of 351,531 patients who underwent noncardiac, nonvascular, and non-neurologic surgery in the authors' hospital between January 2003 and December 2016 were retrospectively reviewed. PAIS occurred in 100 patients. The incidence of PAIS (overall 2.8/10,000) was significantly lower in patients <45 years old (0.12/10,000) than in patients >75 years old (15.79/10,000; p < 0.001). The in-hospital mortality rate was higher among patients with PAIS (26%) than among patients without PAIS (0.34%; p < 0.01). Multiple logistic regression analysis revealed the following independent risk factors for in-hospital mortality: preoperative atrial fibrillation (odds ratio [OR] 9.013, 95% confidence interval [CI] 1.400-58.016; p = 0.021), disturbance of consciousness as the first PAIS symptom (OR 5.561, 95% CI 1.521-20.332; p = 0.009), no anticoagulant/antiplatelet therapy after PAIS (OR 8.196, 95% CI 1.017-66.065; p= 0.048), diuretic treatment (OR 4.942, 95% CI 1.233-19.818; p = 0.024), and pulmonary infection (OR 6.979, 95% CI 1.853-26.291; p = 0.004).ConclusionsThe risk of PAIS after noncardiac, nonvascular, and non-neurologic surgery significantly increased with age, and development of PAIS increased the mortality rate. Among these patients, the independent predictors of in-hospital mortality were preoperative atrial fibrillation, disturbance of consciousness as the first PAIS symptom, no anticoagulant/antiplatelet therapy after PAIS, diuretic treatment, and pulmonary infection.Copyright © 2019 Elsevier Inc. All rights reserved.

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