Abstract
Background: There is an under-recognised patient cohort at elevated risk of postoperative ischaemic stroke. We aimed to develop and validate a prognostic model for the identification of such patients at high risk of ischaemic stroke within 1 yr after noncardiac surgery. Methods: This was a hospital registry study of adult patients undergoing noncardiac surgery between 2005 and 2017 at two independent healthcare networks in Massachusetts, USA without a preoperative indication for therapeutic anticoagulation. Logistic regression was used to fit a model from a priori defined candidate predictors for the outcome 1 yr postoperative ischaemic stroke. To enhance clinical applicability, the model was simplified to a scoring system and externally validated. Results: In the development (n=107 756) and validation (n=141 724) cohorts, 1.4% and 0.5% of patients had an ischaemic stroke up to 1 yr postoperatively. The final model included 13 variables (patient characteristics, comorbidities, procedural factors), considering sub-models conditional on a previous history of ischaemic stroke. Areas under the curve were 0.89 (95% confidence interval 0.89–0.90) and 0.88 (95% confidence interval 0.86–0.89) in the development and validation cohorts. Decision curve analysis indicated positive net benefits superior to other prediction instruments. Conclusions: Stroke after surgery (STRAS) screening can reliably identify patients with a high risk for ischaemic stroke during the first year after surgery. A STRAS-guided risk stratification may inform the recruitment to future randomised trials testing the efficacy of treatments for the prevention of postoperative ischaemic stroke.
Original language | English (US) |
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Pages (from-to) | 713-721 |
Number of pages | 9 |
Journal | British Journal of Anaesthesia |
Volume | 127 |
Issue number | 5 |
DOIs | |
State | Published - Nov 2021 |
Keywords
- anticoagulation
- ischaemic stroke
- prognostic factor
- stroke prevention
- surgery
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine