Effect of Time Interval Between Previous Stroke and the Following Surgical Procedure on Recurrent Stroke during Perioperative Period

• Main Authors: Yu-Fang Liu, 劉羽芳
• Other Authors: 王中儀
• Format: Others
• Language: en_US
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/32047881826035056254

碩士 === 中國醫藥大學 === 醫務管理學系碩士在職專班 === 99 === Background and Purpose: As one of the most costly diseases, stroke is also a major cause of morbidity and mortality in the general population. American Heart Association reported in 2010 that approximately 795,000 people in US suffered from new or recurrent stroke yearly. Recurrent stroke accounted for 25~30% of all strokes, and therefore, prevention of stroke recurrence is important to both individual and public health. History of stroke and symptoms of cerebrovascular insufficiency are the significant predictors of perioperative stroke. Elective surgery should be considered pending if a stroke or transient neurologic deficit has occurred recently. However, data are lacking on the safe time interval between previous stroke and the following surgical procedure (stroke-to-surgery time interval). This research sought to investigate a reasonable time interval between the previous stroke and the following surgical intervention that is considered safe among patients with history of stroke. Methods: Data source is the longitudinal National Health Insurance Research Database (NHIRD) 2002~2009 with original claims data for 1,000,000 randomly sampled beneficiaries. In the design of retrospective cohort study, a total of 9,414 first-time stroke patients (ICD-9-CM codes 430-438) who subsequently underwent any surgical procedures one months later were included in the sample. Emergent surgeries, cardio-vascular and any related neurosurgical surgeries were excluded. SAS 9.1 was used to perform descriptive and inferential statistics, including Chi-square, bivariate and multivariate logistic regressions to generalize the effects of time-interval and related factors on perioperative recurrent stroke. Result: Of all the sample, 626 (6.65%) experienced stroke recurrence. Female (OR=0.744; 95% CI=0.627-0.881; p=0.0006) showed lower odds of perioperative stroke recurrence, while hypertension (OR=1.584; 95% CI=1.253-2.001; p=0.0001), atrial fibrillation (OR=2.648; 95% CI=1.789-3.920; p<0.0001), and hypercholesterolemia (OR=3.398; 95% CI=2.497-4.622; p<0.0001) exhibited higher, among first-time stroke patients receiving elective surgeries. Chi-square and logistic regression results both proved that longer stroke-to-surgery time interval was significantly associated with lower odds of perioperative stroke recurrence. Stroke-to-surgery time interval at 10-12 months (OR=0.625; 95% CI=0.425-0.919; p=0.0170) and ≧12 months (OR=0.645; 95% CI=0.501-0.830; p=0.0007) showed evidence of lower perioperative stroke recurrence. Conclusion: A safe ≧10 months of stroke-to-surgery time interval significantly lowered the likelihood of perioperative stroke recurrence. Therefore, elective surgeries with no urgency should not be performed until 10 months of stroke-to-surgery time interval is reached. We also suggest that the implication of stroke-to-surgery time interval on preventive medicine merits more attention among stroke practitioners.