Incidence and Risk Factors of Perioperative Stroke
in Siriraj Hospital
Pachara Leemingsawat MD*,
Suneerat Kongsayreepong MD**, Chulaluk Komoltri DrPH (Biostatistics)***,
Naraporn Prayoonwiwat MD*, Yongchai Nilanont MD*
Affiliation :
* Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Division of Clinical Epidemiology, Department of Research Development, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Background : Data concerning perioperative stroke incidence and risk factors are lacking in Thailand.
Objective : To study incidence and risk factors of perioperative stroke in Siriraj Hospital, Bangkok, Thailand.
Material and Method: The authors conducted a nested case-control study between July 2007 and June 2010. Consecutive
perioperative stroke cases were compared with age-matched controls that had undergone surgery without having a stroke
at a 1:4 ratio. Patients’ characteristics, co-morbidities, clinical manifestation, stroke subtypes, duration, and types of surgery
were collected. Multiple logistic regression analysis was performed to identify factors associated with a stroke during
perioperative period.
Results : Sixty-six patients with perioperative stroke from 99,283 that underwent surgery were included. This resulted in an
incidence of 66.5/100,000. Men comprised 65.2%. Mean age of stroke patients was 66.6-years-old. Age-match controls
included 264 consecutive patients who underwent surgery without having a stroke. A multivariate analysis showed that
male sex (adjusted OR 3.1, p = 0.003), surgical types: open heart surgery (adjusted OR 54.3, p < 0.0001), vascular surgery
(adjusted OR 20.6, p < 0.0001) and endovascular procedure (adjusted OR 15.4, p < 0.0001), emergency surgery (adjusted
OR 8.3, p < 0.0001), the presence of diabetes mellitus (adjusted OR 2.6, p = 0.018), chronic kidney disease (adjusted OR
2.6, p = 0.027), and coronary artery disease (adjusted OR 0.4, p = 0.039) were associated with perioperative stroke.
Conclusion : Incidence of perioperative stroke was higher than a previous report. Male, type of surgery, emergency operation,
diabetes mellitus, and chronic kidney disease were risk factors of perioperative stroke.
Keywords : Perioperative stroke, Incidence, Risk factors
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