History of Stroke Increases Risk of Elective Noncardiac Surgery

A Danish population-based study suggests that elective, noncardiac surgery is especially risky in patients with a recent history of ischemic stroke.

Mads Jorgenson, MB, of the University of Copenhagen, and colleagues studied all patients aged 20 years or older who underwent elective noncardiac surgeries from 2005 through 2011 in Danish national registries, among whom 7,137 had a history of stroke and 474,046 did not. Overall, major adverse cardiovascular outcomes (ischemic stroke, acute myocardial infarction, and cardiovascular mortality) occurred at a rate of 54.4 per 1,000 patients after surgery in the stroke group, compared with 4.1 per 1,000 in nonstroke patients. The study’s results were published in JAMA.

The odds of a major adverse cardiovascular event were more than 14-fold higher when the surgeries were done within the first 3 months after stroke compared with surgery in patients with no stroke history. The odds declined after 3 months with risk leveling off after 9 months for the stroke group (P<0.01 for nonlinearity). However, that was still twice the rate for nonstroke patients even a year or more after stroke.

The same pattern was seen with respect to mortality, the researchers said. All-cause 30-day mortality was 35.6 per 1,000 patients with prior stroke compared with 6.1 per 1,000 patients without a stroke history.

Furthermore, low- and intermediate-risk surgeries posed the same relative risk of a major adverse cardiovascular event in patients with recent strong compared with high-risk surgery.

The investigators suggest that it is important to consider a history of recent stroke, including when considering minor surgical procedures.