J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Short Communication

Volume 15, Number 5, May 2023, pages 268-273

Timing of Postoperative Stroke and Risk of Mortality After Noncardiac Surgery: A Cohort Study

**Table 1.** Characteristics of 16,750 Patients ≥ 18 Years of Age or Older Who Developed Stroke After Noncardiac Surgery (NSQIP 2010 - 2019)
Characteristics	No. of patients (%)
ASA: American Society of Anesthesiologists; COPD: chronic obstructive pulmonary disease.
Study population	16,750 (100.0)	11,173 (66.7)	5,577 (33.2)
Male sex	8,122 (48.5)	5,390 (48.2)	2,732 (49)
Age
< 65	4,939 (30.4)	3,300 (30.4)	1,639 (30.3)
65 - 74	4,911 (30.2)	3,280 (30.2)	1,631 (30.2)
75 - 84	4,209 (25.9)	2,824 (26)	1,385 (25.6)
≥ 85	2,193 (13.5)	1,441 (13.3)	752 (13.9)
Body mass index (kg/m²)	27 (24 - 32)	27 (23 - 32)	28 (24 - 32)
ASA classification ≥ 3	14,762 (88.4)	9,882 (88.7)	4,880 (87.8)
Diabetes mellitus
None	11,823 (70.6)	7,948 (71.1)	3,875 (69.5)
Noninsulin	2,409 (14.4)	1,512 (13.5)	897 (16.1)
Insulin	2,518 (15)	1,713 (15.3)	805 (14.4)
Systemic sepsis
None	13,828 (82.7)	9,243 (82.9)	4,585 (82.4)
Systemic inflammatory response syndrome	1,463 (8.7)	992 (8.9)	471 (8.5)
Sepsis	795 (4.8)	492 (4.4)	303 (5.4)
Septic shock	635 (3.8)	429 (3.8)	206 (3.7)
Smoker within 1 year of surgery	3,663 (21.9)	2,457 (22)	1,206 (21.6)
Ventilator-dependent	732 (4.4)	538 (4.8)	194 (3.5)
Emergency case	3,354 (22.3)	2,287 (22.7)	1,067 (21.4)
On dialysis prior to surgery	667 (4)	398 (3.6)	269 (4.8)
Functional dependency	2,016 (12.1)	1,280 (11.6)	736 (13.3)
Congestive heart failure	776 (4.6)	487 (4.4)	289 (5.2)
History of severe COPD	1,770 (10.6)	1,155 (10.3)	615 (11)
Hypertension requiring medication	12,468 (74.4)	8,272 (74)	4,196 (75.2)
Weight loss prior to surgery	533 (3.5)	322 (3.2)	211 (4.2)
Transfusion 72 h before surgery	758 (4.5)	514 (4.6)	244 (4.4)
Ascites	176 (1.1)	102 (0.9)	74 (1.3)
Renal failure	286 (1.9)	179 (1.8)	107 (2.1)

Table 1. Characteristics of 16,750 Patients ≥ 18 Years of Age or Older Who Developed Stroke After Noncardiac Surgery (NSQIP 2010 - 2019)

Characteristics

No. of patients (%)

Overall

Early postoperative stroke (≤ 7 days following surgery)

Delayed postoperative stroke (> 7 days following surgery)

ASA: American Society of Anesthesiologists; COPD: chronic obstructive pulmonary disease.

Study population

16,750 (100.0)

11,173 (66.7)

5,577 (33.2)

Male sex

8,122 (48.5)

5,390 (48.2)

2,732 (49)

Age

< 65

4,939 (30.4)

3,300 (30.4)

1,639 (30.3)

65 - 74

4,911 (30.2)

3,280 (30.2)

1,631 (30.2)

75 - 84

4,209 (25.9)

2,824 (26)

1,385 (25.6)

≥ 85

2,193 (13.5)

1,441 (13.3)

752 (13.9)

Body mass index (kg/m²)

27 (24 - 32)

27 (23 - 32)

28 (24 - 32)

ASA classification ≥ 3

14,762 (88.4)

9,882 (88.7)

4,880 (87.8)

Diabetes mellitus

None

11,823 (70.6)

7,948 (71.1)

3,875 (69.5)

Noninsulin

2,409 (14.4)

1,512 (13.5)

897 (16.1)

Insulin

2,518 (15)

1,713 (15.3)

805 (14.4)

Systemic sepsis

None

13,828 (82.7)

9,243 (82.9)

4,585 (82.4)

Systemic inflammatory response syndrome

1,463 (8.7)

992 (8.9)

471 (8.5)

Sepsis

795 (4.8)

492 (4.4)

303 (5.4)

Septic shock

635 (3.8)

429 (3.8)

206 (3.7)

Smoker within 1 year of surgery

3,663 (21.9)

2,457 (22)

1,206 (21.6)

Ventilator-dependent

732 (4.4)

538 (4.8)

194 (3.5)

Emergency case

3,354 (22.3)

2,287 (22.7)

1,067 (21.4)

On dialysis prior to surgery

667 (4)

398 (3.6)

269 (4.8)

Functional dependency

2,016 (12.1)

1,280 (11.6)

736 (13.3)

Congestive heart failure

776 (4.6)

487 (4.4)

289 (5.2)

History of severe COPD

1,770 (10.6)

1,155 (10.3)

615 (11)

Hypertension requiring medication

12,468 (74.4)

8,272 (74)

4,196 (75.2)

Weight loss prior to surgery

533 (3.5)

322 (3.2)

211 (4.2)

Transfusion 72 h before surgery

758 (4.5)

514 (4.6)

244 (4.4)

Ascites

176 (1.1)

102 (0.9)

74 (1.3)

Renal failure

286 (1.9)

179 (1.8)

107 (2.1)

**Table 2.** Associations Between Timing of Stroke and Surgical Mortality Among 16,750 Patients Who Developed Postoperative Stroke After Non-Cardiac Surgery
	Mortality n/N (%)	Crude	Multivariable
Adjusted analyses were controlled for age, sex, body mass index, American Society of Anesthesiologists (ASA) physical status class, ventilator dependence, emergency surgery, systemic sepsis and other binary variables providing information about the patient’s preoperative comorbidities including dialysis dependence, current tobacco use, diabetes mellitus, congestive heart failure within 30 days before surgery, history of chronic obstructive pulmonary disease requiring chronic bronchodilator therapy, history of myocardial infarction within 6 months before surgery, and hypertension requiring medication. OR: odds ratio; CI: confidence interval.
Delayed postoperative stroke	1,083/5,577 (19.4)	Reference		Reference
Early postoperative stroke	2,785/11,173 (24.9)	1.38 (1.27, 1.49)	<0.01	1.39 (1.29, 1.52)	<0.01

Table 2. Associations Between Timing of Stroke and Surgical Mortality Among 16,750 Patients Who Developed Postoperative Stroke After Non-Cardiac Surgery

Mortality n/N (%)

Crude

Multivariable

OR (95% CI)

P-value

OR (95% CI)

P-value

Adjusted analyses were controlled for age, sex, body mass index, American Society of Anesthesiologists (ASA) physical status class, ventilator dependence, emergency surgery, systemic sepsis and other binary variables providing information about the patient’s preoperative comorbidities including dialysis dependence, current tobacco use, diabetes mellitus, congestive heart failure within 30 days before surgery, history of chronic obstructive pulmonary disease requiring chronic bronchodilator therapy, history of myocardial infarction within 6 months before surgery, and hypertension requiring medication. OR: odds ratio; CI: confidence interval.

Delayed postoperative stroke

1,083/5,577 (19.4)

Reference

Early postoperative stroke

2,785/11,173 (24.9)

1.38 (1.27, 1.49)

<0.01

1.39 (1.29, 1.52)

<0.01