Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale

Authors

Pedro Villablanca, Henry Ford HealthFollow
Alejandro Lemor, Henry Ford HealthFollow
Chak-Yu So, Henry Ford HealthFollow
Guson Kang, Henry Ford HealthFollow
Tarun Jain, Henry Ford HealthFollow
Tanush Gupta
Tomo Ando
Divyanshu Mohananey
Sagar Ranka
Dagmar F. Hernandez-Suarez
Pablo Michel
Tiberio Frisoli
Dee Dee Wang, Henry Ford HealthFollow
Marvin H Eng, Henry Ford HealthFollow
William O'Neill, Henry Ford HealthFollow
Harish Ramakrishna

Recommended Citation

Villablanca PA, Lemor A, So CY, Kang G, Jain T, Gupta T, Ando T, Mohananey D, Ranka S, Hernandez-Suarez DF, Michel P, Frisoli T, Wang DD, Eng M, O'Neill W, and Ramakrishna H. 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 2020.

Document Type

Article

Publication Date

1-16-2020

Publication Title

Journal of cardiothoracic and vascular anesthesia

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 MAIN RESULTS: 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.

PubMed ID

32127264

ePublication

ePub ahead of print