Perioperative stroke in noncardiac, nonneurosurgical surgery

Anesthesiology. 2011 Oct;115(4):879-90. doi: 10.1097/ALN.0b013e31822e9499.


Perioperative stroke after noncardiac, nonneurosurgical procedures is more common than generally acknowledged. It is reported to have an incidence of 0.05-7% of patients. Most are thrombotic in origin and are noted after discharge from the postanesthetic care unit. Common predisposing factors include age, a previous stroke, atrial fibrillation, and vascular and metabolic diseases. The mortality is more than two times greater than in strokes occurring outside the hospital. Delayed diagnosis and a synergistic interaction between the inflammatory changes normally associated with stroke, and those normally occurring after surgery, may explain this increase. Intraoperative hypotension is an infrequent direct cause of stroke. Hypotension will augment the injury produced by embolism or other causes, and this may be especially important in the postoperative period, during which monitoring is not nearly as attentive as in the operating room. Increased awareness and management of predisposing risk factors with early detection should result in improved outcomes.

Publication types

  • Review

MeSH terms

  • Cardiac Surgical Procedures
  • Comorbidity
  • Humans
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / mortality
  • Intraoperative Complications / therapy*
  • Perioperative Period
  • Postoperative Complications / epidemiology
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy*
  • Risk Assessment
  • Risk Management
  • Stroke / epidemiology
  • Stroke / etiology*
  • Stroke / mortality
  • Stroke / prevention & control
  • Surgical Procedures, Operative*