Anesthesiologists’ perception of perioperative stroke risk during non-neurologic and non-cardiac surgery

Sewell, Darreul; Gelb, Adrian W.; Meng, Lingzhong; Chui, Jason; Flexman, Alana M.

doi:10.1007/s12630-017-1011-0

Cited by 8 publications

(8 citation statements)

References 6 publications

(6 reference statements)

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“…4 This risk assessment is an important message to convey, because high-risk patients are infrequently counseled regarding perioperative stroke risk. 34…”

Section: Risk Factors and Incidencementioning

confidence: 99%

Stroke in Surgical Patients

Vlisides

Moore

2021

Anesthesiology

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Stroke is associated with substantial morbidity and mortality. The aim of this review is to provide an evidence-based synthesis of the literature related to perioperative stroke, including its etiology, common risk factors, and potential risk reduction strategies. In addition, the authors will discuss screening methods for the detection of postoperative cerebral ischemia and how multidisciplinary collaborations, including endovascular interventions, should be considered to improve patient outcomes. Lastly, the authors will discuss the clinical and scientific knowledge gaps that need to be addressed to reduce the incidence and improve outcomes after perioperative stroke.

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“…4 This risk assessment is an important message to convey, because high-risk patients are infrequently counseled regarding perioperative stroke risk. 34…”

Section: Risk Factors and Incidencementioning

confidence: 99%

Stroke in Surgical Patients

Vlisides

Moore

2021

Anesthesiology

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“…In a previous study, most anesthesiologists believed it was important to discuss stroke risk with patients although less than half did so routinely. 27 Such discussions may be impeded by knowledge gaps regarding perioperative stroke risk amongst anesthesiologists. 27,28 Surprisingly, we identified patients scheduled for elective non-cancer surgery within six months of stroke or TIA, despite evidence that a nine-month interval is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…27 Such discussions may be impeded by knowledge gaps regarding perioperative stroke risk amongst anesthesiologists. 27,28 Surprisingly, we identified patients scheduled for elective non-cancer surgery within six months of stroke or TIA, despite evidence that a nine-month interval is warranted. 29 This likely reflects a knowledge gap in perioperative healthcare providers and highlights the need to increase awareness of perioperative stroke.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and perceptions about perioperative stroke: a cross-sectional survey of patients scheduled for non-neurologic and non-cardiac surgery

Roughead

Chui

Gelb

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Perioperative stroke is associated with significant morbidity and mortality yet patients may not be aware of their risk or receive appropriate counselling. Our objectives were to 1) compare patient's perceived vs calculated risk of stroke; 2) determine level of worry; and 3) assess prior discussion about perioperative stroke risk amongst elective patients undergoing non-cardiac, nonneurologic surgery. Methods Over a consecutive four-week period, surveys were distributed at two pre-anesthetic clinics to adult patients scheduled for non-cardiac, non-neurologic surgery. The survey included questions about demographics, perioperative stroke risk factors, patient perception of their quantitative and qualitative stroke risk, level of worry about stroke, and risk discussions. We identified independent predictors of risk underestimation amongst medium-and high-risk patients. Results Six hundred patients completed the survey (response rate 78%). Of these, 479, 104, and 15 patients were classified as low-, medium-, and high-risk, respectively (with two patients missing this data point). Most medium-(86%) and high-risk (80%) patients did not identify their elevated risk. Amongst medium-and high-risk patients, independent predictors of risk underestimation were lower education and absence of kidney disease. Medium-and high-risk patients were more worried than low-risk patients about perioperative stroke (median [interquartile range] visual analogue scale score 2 [0.5-4] vs 1 [0-2], P = 0.001). Fewer than half of patients had discussed perioperative stroke previously (40%, 23%, and Electronic supplementary material The online version of this article (

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“…Although perioperative stroke is a significant source of perioperative morbidity and mortality, many patients and anaesthetists underestimate the incidence and impact on postoperative mortality. 5,6 A large retrospective analysis of the US National Inpatient Sample (NIS) found that non-fatal stroke occurred in 0.54% of patients undergoing non-cardiac surgery, similar to the rate of non-fatal acute myocardial infarction (0.76%). 7 Data from 523,059 non-cardiac, nonneurological surgical patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database showed an overall incidence for perioperative stroke of 0.1%, increasing to 1.9% in a subset of highrisk patients.…”

Section: Incidence and Epidemiology Of Perioperative Strokementioning

confidence: 98%

“…3 Many anaesthetists believe intraoperative hypotension is a common cause. 5 However, perioperative strokes resulting solely from hypoperfusion are relatively uncommon.…”

Section: Definition and Aetiology Of Perioperative Strokementioning

confidence: 99%

Perioperative stroke after non-cardiac, non-neurological surgery

Lindberg

Flexman

2021

BJA Education

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Learning objectivesBy reading this article, you should be able to: Identify patients with risk factors for perioperative stroke. Implement perioperative optimisation strategies for high risk patients. Discuss issues related to postoperative screening and management of stroke. Discuss recent evidence about the frequency and sequelae of covert perioperative stroke.Perioperative stroke is a devastating complication of surgery that is relatively under-recognised and uncharacterised compared with other perioperative complications. Although the reported incidence varies by population studied, approximately 0.1e1.9% of patients having non-cardiac, non-neurological surgery will experience a stroke. 1,2 The consequences of perioperative stroke can be devastating and these patients do poorly, with a rate of disability and mortality higher than after stroke unrelated to surgery. Although perioperative stroke is relatively understudied compared with postoperative complications of similar incidence and severity, recent evidence has provided more insight into how we can prevent, identify and manage this complication. We provide a narrative review of the evidence summarising the definitions, epidemiology, prevention and management of perioperative Clinical scenarioA 75-yr-old man presents for total knee replacement. Further questioning reveals that he suffered an ischaemic stroke 2 months ago, and has mild residual weakness of his left hand. He has a history of atrial fibrillation and takes warfarin. Should you delay his surgery? How should you manage his anticoagulation?

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Anesthesiologists’ perception of perioperative stroke risk during non-neurologic and non-cardiac surgery

Cited by 8 publications

References 6 publications

Stroke in Surgical Patients

Stroke in Surgical Patients

Knowledge and perceptions about perioperative stroke: a cross-sectional survey of patients scheduled for non-neurologic and non-cardiac surgery

Perioperative stroke after non-cardiac, non-neurological surgery

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