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

Abstract

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 (

Stroke in Surgical Patients

“…39 Those with high stroke risk also tend to underestimate their risk of stroke. 40 As such, appropriate counseling for highrisk patients seems warranted to increase risk awareness and improve the informed consent process. Risk prediction models discussed previously can be used to estimate risk for a noncardiac surgery patient.…”

Perioperative stroke after non-cardiac, non-neurological surgery

“…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.…”

“…Older age 1,2,6,7 Vascular surgery 6 History of prior stroke or TIA 1,2,8,21 Thoracic surgery 1,6 Hypertension 2 Transplant surgery 6 History of atrial fibrillation 1 Endocrine surgery 6 Valvular disease 1 Burn surgery 6 Cardiovascular disease 1,2 Otolaryngology surgery 6 Renal disease 1,2 Hemicolectomy 1 Diabetes mellitus 1 Smoker or COPD 2 Patent foramen ovale 9 Migraine with or without aura 10 Perioperative management of beta-blocker therapy…”

The preoperative assessment of the stroke risk in oncosurgery

“…Оценка риска инсульта является важной частью предоперационной подготовки в связи с серьезным влиянием функционального состояния центральной нервной системы на качество жизни пациентов. Летальность вследствие периоперационного инсульта в общехирургической практике может достигать 45 %, у пациентов, ранее перенесших острое нарушение мозгового кровообращения, -86 % [7]. В исследовании Perioperative Ischemic Evaluation Study около 60 % пациентов, перенесших периоперационный инсульт, нуждались в длительном уходе, и лишь у 17 % отмечалось полное восстановление функций [8]…”