Risk factor analysis of postoperative cerebral infarction in thoracic surgery patients by propensity-score matching-a single institution retrospective cohort study

BACKGROUND: Postoperative cerebral infarction (PCI) is serious complication for thoracic surgery patients, however, the risk factors still unclear. This study sought to investigate the incidence risk factors of postoperative cerebral infarction after thoracic surgery. METHODS: Patients who underwent thoracic surgery from 2011 to 2022 at Beijing Chaoyang Hospital were identified and followed-up for 30 days postoperatively to determine the primary outcome of PCI. Patients with PCI were identified as the PCI cohort, and those without PCI were identified as the non-PCI cohort. The clinical data of all the patients were collected. The Mann-Whitney U test and chi-square test were used to analyze the baseline differences. Propensity-score matching (PSM) at a ratio of 1:4 was used to match the variables between the 2 cohorts, and a stepwise univariate conditional logistic regression was used to analyze the risk factors of PCI. RESULTS: We enrolled 8,448 consecutive patients who underwent thoracic surgeries, including 21 with PCI and 8,827 without PCI. Among the 21 PCI patients, 6 patients died. A history of cerebral infarction [odds ratio (OR) = 4.38, P=0.037], perioperative blood transfusion (OR =6.22, P=0.013), a history of deep vein thrombosis (DVT) (OR =5.25, P=0.022), and hyperlipidemia (OR =13.76, P<0.01) were identified as independent risk factors among all the factors by the univariate logistical analysis after the PSM of the other covariates at a ratio of 1:4. CONCLUSIONS: PCI patients who undergo thoracic surgery have a poor prognosis. A history of cerebral infarction, perioperative blood transfusion, a history of DVT, and hyperlipidemia are risk factors of PCI. Patients with risk factors may need prevention measure and assist clinician for early diagnosis of PCI.