Abstract
Patients who previously suffered a stroke have increased risks of mortality and complications after surgeries, but the optimal anesthesia method is not fully understood. We aimed to compare the outcomes after surgeries for stroke patients who received general anesthesia (GA) and neuraxial anesthesia (NA). Using health insurance research data, we identified 36,149 stroke patients who underwent surgeries from 1 January 2008 to 31 December 2013. For balancing baseline covariates, the propensity-score-matching procedure was used to select adequate surgical patients who received GA and NA at a case–control ratio of 1:1. Multiple logistic regressions were applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative mortality and complications between surgical patients with prior stroke who received GA and NA. Among the 4903 matched pairs with prior stroke, patients with GA had higher risks of pneumonia (OR 2.00, 95% CI 1.62–2.46), pulmonary embolism (OR 3.30, 95% CI 1.07–10.2), acute renal failure (OR 3.51, 95% CI 1.13–2.10), intensive care unit stay (OR 3.74, 95% CI 3.17–4.41), and in-hospital mortality (OR 2.02, 95% CI 1.16–3.51) than those who received NA. Postoperative adverse events were associated with GA in patients aged more than 60 years and those who received digestive surgery (OR 3.11, 95% CI 2.08–4.66). We found that stroke patients undergoing GA had increased postoperative complications and mortality after surgery compared with those who received NA. However, these findings need more validation and evaluation by clinical trials.
Highlights
Introduction distributed under the terms andStroke remains a major global epidemic disease, affecting approximately 104 million individuals and accounting for 11.8% of all deaths worldwide [1,2]
After adjustment for the propensity scores (Table 2), stroke patients with GA had significantly higher odds for postoperative bleeding, pneumonia, septicemia, acute renal failure
An analysis of data stratified by sex and age (Table 3) showed that GA was associated with postoperative adverse events in men, women, and patients aged 60–69 years, 70–79 years, and ≥80 years
Summary
Stroke remains a major global epidemic disease, affecting approximately 104 million individuals and accounting for 11.8% of all deaths worldwide [1,2]. The global estimation shows that the lifetime risk of stroke for people aged 25 years or older increased from 22.8%. Patients with prior stroke have a higher risk of perioperative conditions of the Creative Commons. Complications due to their pre-existing neurological disability, concomitant diseases, and vulnerability to the effects of anesthesia and surgery [4–6]. Anesthesia in surgery causes alterations in cardiac output, vascular resistance, blood pressure, and oxygen supply, which can prevent the development of postoperative complications in stroke patients [7]. It has been reported that NA (neuraxial anesthesia) for major truncal and lower limb surgery is associated with a lower risk of postoperative complications than GA (general anesthesia), including pulmonary complications, wound infection, and thromboembolism [8]. The previous study demonstrated an increased risk of DNA damage after GA compared to NA [10]
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