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Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery

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Abstract

Purpose

The association between intraoperative hypotension and perioperative acute ischemic stroke is not well described. We hypothesized that intraoperative hypotension would be associated with perioperative acute ischemic stroke.

Methods

Four-year retrospective cohort study of elective non-cardiovascular, non-neurological surgical patients. Characteristics of patients who had perioperative acute ischemic stroke were compared against those of patients who did not have acute ischemic stroke. Multivariable logistic regression was used to determine whether hypotension was independently associated with increased odds of perioperative acute ischemic stroke.

Results

Thirty-four of 9816 patients (0.3%) who met study inclusion criteria had perioperative acute ischemic stroke. Stroke patients were older and had more comorbidities including hypertension, coronary artery disease, diabetes mellitus, active tobacco use, chronic obstructive pulmonary disease, cerebral vascular disease, atrial fibrillation, and peripheral vascular disease (all P < 0.05). MAP < 65 mmHg was not associated with increased odds of acute ischemic stroke when modeled as a continuous or categorical variable. MAP < 60 mmHg for more than 20 min was independently associated with increased odds of acute ischemic stroke, OR = 2.67 [95% CI = 1.21 to 5.88, P = 0.02].

Conclusion

Our analysis suggests that when MAP is less than 60 mmHg for more than 20 min, there is increased odds of acute ischemic stroke. Further studies are needed to determine what MAP should be targeted during surgery to optimize cerebral perfusion and limit ischemic stroke risk.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene Street, S11C00, Baltimore, MD, 21201, USA

    Michael Mazzeffi, Jonathan H. Chow, Megan Anders, Miranda Gibbons, Douglas Martz & Peter Rock

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Uwagbale Okojie, Amber Feng & Ikeoluwapo Ibrahim

  3. Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA

    Nicholas A. Morris

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  1. Michael Mazzeffi
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  2. Jonathan H. Chow
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  3. Megan Anders
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  5. Uwagbale Okojie
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  8. Nicholas A. Morris
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Correspondence to Michael Mazzeffi.

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Mazzeffi, M., Chow, J.H., Anders, M. et al. Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery. J Anesth 35, 246–253 (2021). https://doi.org/10.1007/s00540-021-02901-3

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  • DOI: https://doi.org/10.1007/s00540-021-02901-3

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