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Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

OBJECTIVE: Stroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk...

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Autores principales: Hsieh, Cheng-Yang, Huang, Chin-Wei, Wu, Darren Philbert, Sung, Sheng-Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218083/
https://www.ncbi.nlm.nih.gov/pubmed/30395587
http://dx.doi.org/10.1371/journal.pone.0206990
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author Hsieh, Cheng-Yang
Huang, Chin-Wei
Wu, Darren Philbert
Sung, Sheng-Feng
author_facet Hsieh, Cheng-Yang
Huang, Chin-Wei
Wu, Darren Philbert
Sung, Sheng-Feng
author_sort Hsieh, Cheng-Yang
collection PubMed
description OBJECTIVE: Stroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk of ischemic stroke in these patients. METHODS: We included adult patients with the first hospitalization for ischemic stroke between 2011 and 2012 from 23 million enrollees in the National Health Insurance Research Database. Admission date of the hospitalization was defined as the case day and exactly 365 days before the admission date as the control day. The exposure was the last hospitalization for surgery within 1–30, 31–60, or 61–90 days (case period) before the case day or similar time intervals (control period) before the control day. Surgical types were grouped based on the International Classification of Diseases procedure codes. We performed conditional logistic regression adjusting for time-varying variables to determine the relationship between surgery and subsequent stroke, and case-time-control analyses to examine whether the results were confounded by the time-trend in surgery. RESULTS: A total of 56596 adult patients (41% female, mean age 69 years) comprised the study population. After adjustment was made for confounding variables, an association between stroke and prior inpatient surgery within 30 days was observed (adjusted odds ratio 1.44; 95% confidence interval 1.29–1.61). Cardiothoracic, vascular, digestive surgery, and musculoskeletal surgery within 30 days independently predicted ischemic stroke in the case-crossover analysis. In the case-time-control analysis, inpatient surgery remained an independent risk factor for ischemic stroke, whereas only cardiothoracic, vascular, and digestive surgery independently predicted ischemic stroke. CONCLUSIONS: Surgery as a whole independently increased the risk of ischemic stroke within 30 days. Among various types of surgery, cardiothoracic, vascular, and digestive surgery significantly increased the risk of ischemic stroke.
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spelling pubmed-62180832018-11-19 Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter? Hsieh, Cheng-Yang Huang, Chin-Wei Wu, Darren Philbert Sung, Sheng-Feng PLoS One Research Article OBJECTIVE: Stroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk of ischemic stroke in these patients. METHODS: We included adult patients with the first hospitalization for ischemic stroke between 2011 and 2012 from 23 million enrollees in the National Health Insurance Research Database. Admission date of the hospitalization was defined as the case day and exactly 365 days before the admission date as the control day. The exposure was the last hospitalization for surgery within 1–30, 31–60, or 61–90 days (case period) before the case day or similar time intervals (control period) before the control day. Surgical types were grouped based on the International Classification of Diseases procedure codes. We performed conditional logistic regression adjusting for time-varying variables to determine the relationship between surgery and subsequent stroke, and case-time-control analyses to examine whether the results were confounded by the time-trend in surgery. RESULTS: A total of 56596 adult patients (41% female, mean age 69 years) comprised the study population. After adjustment was made for confounding variables, an association between stroke and prior inpatient surgery within 30 days was observed (adjusted odds ratio 1.44; 95% confidence interval 1.29–1.61). Cardiothoracic, vascular, digestive surgery, and musculoskeletal surgery within 30 days independently predicted ischemic stroke in the case-crossover analysis. In the case-time-control analysis, inpatient surgery remained an independent risk factor for ischemic stroke, whereas only cardiothoracic, vascular, and digestive surgery independently predicted ischemic stroke. CONCLUSIONS: Surgery as a whole independently increased the risk of ischemic stroke within 30 days. Among various types of surgery, cardiothoracic, vascular, and digestive surgery significantly increased the risk of ischemic stroke. Public Library of Science 2018-11-05 /pmc/articles/PMC6218083/ /pubmed/30395587 http://dx.doi.org/10.1371/journal.pone.0206990 Text en © 2018 Hsieh et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hsieh, Cheng-Yang
Huang, Chin-Wei
Wu, Darren Philbert
Sung, Sheng-Feng
Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title_full Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title_fullStr Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title_full_unstemmed Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title_short Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?
title_sort risk of ischemic stroke after discharge from inpatient surgery: does the type of surgery matter?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218083/
https://www.ncbi.nlm.nih.gov/pubmed/30395587
http://dx.doi.org/10.1371/journal.pone.0206990
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