Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale.
J Cardiothorac Vasc Anesth
; 34(8): 2060-2068, 2020 Aug.
Article
en En
| MEDLINE
| ID: mdl-32127264
ABSTRACT
OBJECTIVES:
To evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes.DESIGN:
Retrospective cohort analysis.SETTING:
United States hospitals.PARTICIPANTS:
Adults patients (≥18 years old) who underwent major noncardiac surgery from 2010 to 2015 were identified using the Healthcare Cost and Utilization Project's National Readmission Database.INTERVENTIONS:
Preoperative diagnosis of ASD or patent foramen ovale. MEASUREMENTS AND MAINRESULTS:
Among the 19,659,161 hospitalizations for major noncardiac surgery analyzed, 12,248 (0.06%) had a preoperative diagnosis of ASD/PFO. Perioperative ischemic stroke occurred in 723 (5.9%) of patients with ASD/PFO and 373,291 (0.02%) of those without ASD/PFO (adjusted odds ratio [aOR], 16.7; 95% confidence interval [CI] 13.9-20.0). Amongst the different types of noncardiac surgeries, obstetric, endocrine, and skin and burn surgery were associated with higher risk of stroke in patients with pre-existing ASD/PFO. Moreover, patients with ASD/PFO also had an increased in-hospital mortality (aOR, 4.6, 95% CI 3.6-6.0), 30-day readmission (aOR, 1.2, 95% CI 1.04-1.38), and 30-day stroke (aOR, 7.2, 95% CI 3.1-16.6). After adjusting for atrial fibrillation, ischemic stroke remained significantly high in the ASD/PFO group (aOR 23.7, 95%CI 19.4-28.9), as well as in-hospital mortality (aOR 5.6, 95% CI 4.1-7.7), 30-day readmission (aOR 1.19, 95%CI 1.0-1.4), and 30-day stroke (aOR 9.3, 95% CI 3.7-23.6).CONCLUSIONS:
Among adult patients undergoing major noncardiac surgery, pre-existing ASD/PFO is associated with increased risk of perioperative ischemic stroke, in-hospital mortality, 30-day stroke, and 30-day readmission after surgery.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Isquemia Encefálica
/
Accidente Cerebrovascular
/
Foramen Oval Permeable
/
Accidente Cerebrovascular Isquémico
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Adult
/
Humans
País como asunto:
America do norte
Idioma:
En
Año:
2020
Tipo del documento:
Article