Clinical and Prognostic Features of Perioperative Stroke: A Multicenter Retrospective Cohort Study

Introduction Perioperative stroke constitutes a major subset of in-hospital stroke. Evidence is lacking on whether procedure-specific risk profiles exist and how they influence functional recovery. We aim to identify distinct clinical features and procedure-specific risk factors associated with perioperative stroke. Methods We retrospectively analyzed a 4-year cohort of patients with in-hospital stroke from 5 tertiary hospitals across China. Clinical data were systematically extracted through electronic medical record review. 90-day functional outcomes were assessed. Multivariate linear regression was performed to identify factors associated with 90-day outcomes in perioperative stroke. Results Out of 1,048,566 hospitalized patients, 166 (0.02%) patients developed in-hospital stroke. Among them, 158 patients completed the 90-day follow-up, with 100 males (63.29%) and a median age of 69 years (IQR, 61-76). 63 (39.87%) had perioperative stroke, with the highest proportion (13.92%) occurring in the cardiology/cardiothoracic surgery departments. Delayed recognition (4 hours [IQR, 1.58-24.00] vs. 2 hours [IQR, 1.00 to 5.50], P=0.020), higher NIHSS score (12 [IQR, 5-30] vs. 9 [IQR, 4-16], P=0.045), and lower proportion of reperfusion therapy (5.56% vs. 28.21%, P=0.003) were observed in patients with perioperative ischemic stroke compared to those with non-perioperative stroke. In subgroup analysis, cardiovascular surgery-related ischemic stroke patients had higher NIHSS score (20 [IQR, 8-35] vs. 8 [IQR, 5-20], P=0.035) and 90-day modified Rankin scale score (4 [IQR, 2-6] vs. 2 [IQR, 1-4], P=0.039) than those non-cardiovascular surgical counterparts. Additionally, they exhibited a trend toward a higher 90-day mortality rate (33.33% vs. 10.71%; OR, 4.17 [95%CI, 1.07 to 20.83]; P=0.052). Conclusion Perioperative in-hospital stroke exhibits distinct clinical characteristics. Cardiovascular-related surgery is associated with worse functional outcomes.