Predictors of Outcome After Perioperative Stroke
试验速览
- 阶段
- 不适用
- 入组人数
- 20,000
- 试验地点
- 1
- 主要终点
- Number of deaths
研究概览
简要总结
Perioperative stroke is a devastating complication of surgery that is currently poorly characterized with limited clinical tools available to detect and prevent its occurrence. The current literature has identified that patients who experience a stroke after surgery have a higher rate of mortality, length of stay and discharge to a facility, but given the rare nature of this complication relatively little is known about which factors predict these outcomes amongst those who experience a perioperative stroke. The study objectives are to identify predictors of mortality, length of stay and discharge disposition after perioperative stroke in non-cardiac, non-neurological surgery using the prospectively-collected American College of Surgeons National Surgical Quality Improvement Program database between 2004 and 2020.
详细描述
BACKGROUND
Perioperative stroke is a devastating complication of surgery that is currently poorly characterized with limited clinical tools available to detect and prevent its occurrence. Perioperative stroke is a cerebrovascular event that occurs after surgery, and affects between 0.1-1.9% of patients having non-cardiac, non-neurologic surgery. Perioperative stroke is relatively understudied compared to postoperative complications of similar incidence and severity, such as cardiac complications. Over the past few decades, significant efforts have been undertaken to reduce the risk of perioperative myocardial infarction and have led to a decrease in incidence over time due to an advancements in risk stratification and perioperative management. Although the incidence of perioperative stroke is similar or higher than that of perioperative myocardial infarction, the risk of this complication has been increasing over time and perioperative stroke remains relatively neglected. The current literature has identified that patients who experience a stroke after surgery have a higher rate of mortality, length of stay and discharge to a facility, but given the rare nature of this complication relatively little is known about which factors predict these outcomes amongst those who experience a perioperative stroke.
OBJECTIVES
SPECIFIC OBJECTIVES
- Derive and externally validate risk prediction models for mortality (primary outcome), adverse discharge, ICU utilization, tracheostomy/PEG/craniectomy, and length of stay after perioperative stroke.
- Describe temporal trends in mortality after perioperative stroke between 2005 and 2020.
- Explore mediators of mortality risk after perioperative stroke.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Derivation cohort: all patients who received a diagnosis of stroke in the NSQIP database between 2004 and
- •Validation cohort: Patients who experienced an ICD-10-CA admission diagnosis (top 3 positions) of AIS within 30 days of admission for surgery, or as a discharge diagnosis from the index surgical hospitalization. Perioperative patients will be further extracted from the overall AIS cohort if they received surgical billing code in the 30 days prior to admission for stroke.
排除标准
- •Patients who underwent a neurosurgical or interventional radiology procedure.
结局指标
主要结局
Number of deaths
时间窗: within 30 days of surgery
death
次要结局
- length of stay(within 30 days of surgery)
- disposition(within 30 days of surgery)
研究者
Alana Flexman
Clinical Associate Professor
University of British Columbia