Raising the Alarm on Brain Attacks in Surgical Patients: Are We Doing Enough to Prevent and Treat Postoperative Strokes?

Abstract

This editorial provides an overview of the study by Christiansen et al, which demonstrates that a history of acute ischemic stroke within 3 months of emergency noncardiac, nonintracranial surgery significantly increased the risk of a postoperative stroke using data from the Danish National Patient Registry. The incidence of postoperative stroke was reported at 0.1% to 0.7%, with the risk declining as more time elapsed between the ischemic event and surgery. Despite the study limitations, this research by Christiansen et al on vulnerability to stroke after surgery supports the need for further research using different approaches and diverse populations to support the validation of the risk. Awareness of the risk of stroke, new neurologic deficits, and clear procedures with stroke teams and perioperative and surgical teams should be in place to ensure better patient outcomes. When undergoing elective surgery, especially in high-risk patients/ procedures, management must be done in close conjunction with stroke teams and comprehensive stroke centers where neuroendovascular specialists and advanced neuroimaging capabilities are readily available to ensure a better quality of care, as well as a better quality of life postprocedure. As of 2017, across America, there are 121 comprehensive stroke centers. When a specialized center is not readily accessible, a protocol to manage at-risk patients via technology, such as telestroke consultation, must be implemented. Currently, the guidelines for preventing postoperative stroke are provided by the Society for Neuroscience in Anesthesiology and Critical Care consensus statement (supported but not endorsed by the American Society of Anesthesiologists). These guidelines have been minimally disseminated in comparison to the information from theAmerican StrokeAssociation. Because of the potential for severe impact on the life of a patient, surgical patients at risk of postoperative stroke must be managed with as much importance given to preventing a recurrent stroke as with dealing with the medical condition being treated.