Epidemiology of cerebral perioperative vascular accidents

• Published in: Annales françaises d'anesthésie et de réanimation Vol. 33; no. 12; pp. 677 - 689
• Main Authors: Rozec, B, Cinotti, R, Le Teurnier, Y, Marret, E, Lejus, C, Asehnoune, K, Blanloeil, Y
• Format: Journal Article
• Language: French
• Published: France 01-12-2014
• Subjects: Cardiac Surgical Procedures - adverse effects; Carotid Arteries - surgery; Humans; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Stroke - epidemiology; Stroke - mortality; Marqueur de qualité; Postoperative period; Stroke; Période postopératoire; General surgery; Mortality; Quality marker; Carotid surgery; Cardiac surgery; Chirurgie générale; Chirurgie carotidienne; Risk factors; Chirurgie non cardiaque et non carotidienne; Onset time; Mortalité; Horaire de survenue; Accident vasculaire cérébral; Non-cardiac non-carotid surgery; Chirurgie cardiaque; Facteurs de risque
• ISSN: 1769-6623
• DOI: 10.1016/j.annfar.2014.09.009

Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature.
Systematic review.
Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters.
In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients.
Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.