Atrial Septal Defect and the Risk of Ischemic Stroke in the Perioperative Period of Noncardiac Surgery
Section snippets
Background
Worldwide, more than 300 million surgeries are performed annually.1 Stroke is a serious complication of surgery that is associated with long-term morbidity and mortality.2 The risk of perioperative stroke varies based on patient characteristics and surgical factors, with the highest risks in patients undergoing cardiac and vascular procedures.2 Congenital defects of the interatrial septum may be a potent risk factor for perioperative stroke. Atrial septal defects (ASD) are present in 1.6 per
Methods
Patients undergoing noncardiac surgery between 2004 and 2014 were identified using the Healthcare Cost and Utilization Project's National Inpatient Sample.12 The NIS is a large administrative database that contains data from more than 7 million hospitalizations in the United States each year. The NIS approximates a 20% stratified sample of all discharges from nonfederal hospitals in the United States.12 Patients were eligible for inclusion if they had a principal International Classification of
Results
Between 2004 and 2014, we identified 639,985 admissions for noncardiac surgery in which in-hospital diagnostic echocardiography was performed. An ASD or PFO was documented in 9,041 (1.4%) of noncardiac surgical hospitalizations with an in-hospital echocardiogram. Patients with a diagnosis of ASD or PFO were younger, more likely to be white, and more likely to have peripheral vascular disorders, a history of venous thromboembolism, and prior stroke compared with patients without ASD or PFO.
Discussion
In this analysis of 639,985 hospitalizations for major noncardiac surgery in the United States, a diagnosis of an ASD or PFO by echocardiography was associated with perioperative acute ischemic stroke, even after adjustment for baseline demographics, cardiovascular risk factors, and comorbidities. Similar associations were identified in a sensitivity analysis excluding patients undergoing vascular surgery. In contrast, ASD or PFO was not associated with an increased risk of MI or in-hospital
Disclosures
The authors report no relationships that could be construed as a conflict of interest
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Cited by (13)
Prevention of perioperative stroke in patients undergoing non-cardiac surgery
2023, The Lancet NeurologyPatent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis
2022, British Journal of AnaesthesiaTotal Joint Arthroplasty in Patients With Atrial Septal Defects: What Are the 90-Day Complications?
2022, Arthroplasty TodayCitation Excerpt :It is estimated to occur in 0.1% to 1.9% of noncardiac surgeries, with 50% occurring within the first postoperative day [3]. ASD and PFO have been identified as risk factors for perioperative strokes, even when controlling for demographic and clinical covariates [1,2,4]. When looking at noncardiac surgeries, patients with ASD/PFO have a higher risk of postoperative ischemic strokes, in-hospital mortality, 30-day stroke, and 30-day readmission after surgery [4].
Risk of Perioperative Stroke in Patients With Patent Foramen Ovale: A Systematic Review and Meta-analysis
2022, Canadian Journal of CardiologyCitation Excerpt :The results of the quality appraisal of included studies are presented in Figure 2. Six (60%) studies26-28,30-32 used a reliable and valid method for PFO diagnosis, ie, echocardiography, and 4 used ICD codes.29,33-35 All patients were free from acute stroke (primary outcome) at the time of surgery; however, no preoperative imaging was included in any of the studies other than in the study by Floyd et al.26
Transesophageal Echocardiography in Noncardiac Thoracic Surgery
2021, Cohen's Comprehensive Thoracic Anesthesia
Sponsor/Funding: Dr. Smilowitz is supported in part by an NYU CTSA grant, UL1 TR001445 and KL2 TR001446, from the National Center for Advancing Translational Sciences, National Institutes of Health.”
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Authors contributed equally to this manuscript.