Analysis Of Risk Factors Associated With Perioperative Stroke In The Elderly

Background and Purpose:Perioperative stroke is a serious complication related to operative intervention.Once it has occurred,it will result in a server consequence for patients.Elderly patients has a special patho-physiological characteristics,there may be a higher perioperative stroke risk.However,at present,there is no authoritative literature research related incidence and risk factors analysis in our country,also lack effective international concise perioperative stroke risk assessment system to guide clinical work.To solve the above problems,the study analyzed in Shaanxi Provincial People’s Hospital for nearly two years various types of surgery in the elderly patients perioperative stroke events,and retrospectively analyzed the related risk factors,clinical guidance for controllable risk factors to take corresponding prevention and treatment measures in advance,reduce the incidence of perioperative stroke and further improve the elderly perioperative patients prognosis.Methods:Data of this research was draw from the record database for Shaanxi Provincial People’s Hospital from January 1,2016 to 2017 on December 31 related surgery during all elderly patients,according to the Surgery Classification and Categories Contents of Chinese Ministry of Health and relevant stroke events including cerebral infarction,cerebral hemorrhage,subarachnoid hemorrhage of diagnostic criteria,according to the stroke events with or without,put all the information in medical record home page the second plane in the column of“operation,the action bar” in elderly patients with surgery(age 60 or higher)into perioperative stroke event groups(case group)and the non-event group(control group).The event group adopt the method of census,the non-event group patients,according to the event groups in surgery type matching 1:5 random sampling investigation to construct nested case-control study as a grouping scheme.The data of the two groups of patients were collected into SPSS22.0(Statistical Package for the Social Sciences)Statistical software,and the data were checked and corrected,and then Statistical analysis was performed.In the first place,according to the normal condition required by the statistical method,all values of the measurement data are represented by`x± s,and t-test and analysis of variance are adopted.For categorical data by χ2 test first,the single factor analysis between the two groups,in order to further filter out whether perioperative stroke in patients with possible influencing factors,the dependent variable is whether perioperative stroke,the class is referred to as a binary classification variables.then all the results of the single factor analysis has significant statistical differences in the various risk factors into two categories of unconditioned Logistic multivariate regression equation model was analyzed,in order to forward the maximum quasi likelihood ratio method for variable selection,finally select a risk factor for clinical significance.P<0.05 was considered to be statistically significant.Results:1.26973 cases of patients enter the preliminary screening,according to inclusion and exclusion criteria,59 patients were included in the event group,and according to the event groups in the operation type matching 1:5 random sampling method to screen out 295 patients were included in the non-event group.2.The total incidence rate of senile perioperative stroke events in the hospital was0.22%,including the incidence of pure cerebral infarction(51 cases),pure cerebral hemorrhage(4 cases),pure subarachnoid hemorrhage(2 cases)and cerebral hemorrhage associated with subarachnoid hemorrhage(2 cases)were respectively 86.4%,6.8%,3.4%,3.4%.the total mortality rate of senile perioperative stroke patients(5 cases)was 8.5%.3.The operation of senile perioperative stroke events in the hospital included: The cardiovascular system(20 cases)accounted for 33.9%;The nervous system(14 cases)accounted for 23.7%;Urinary system(15 cases)accounted for 25.4%;Otolaryngology(5cases)accounted for 8.5%;Osteology(2 cases)accounted for 3.4%;Respiratory system(2cases)accounted for 3.4%;The blood system(1 case)accounted for 1.7%.4.The related risk factors of single factor analysis results: Statistically significant risk factors including: age(P=0.001);History of stroke/TIA(P=0.000);History of atrial fibrillation(P = 0.021).5.The logistic regression analysis results of various risk factors: Statistically significant risk factors including: Advanced age(P=0.020;OR=5.35;95%CI:3.48-18.20);The history of stroke/TIA(P= 0.000;OR = 7.825;95% CI: 2.164-42.570).Conclusions:1.The total incidence of our perioperative stroke events in the low level of foreign research,which is consistent with foreign,perioperative stroke are mainly composed of ischemic stroke and hemorrhagic stroke are relatively rare,and involved in surgery of patients with heart,nervous system,its incidence of perioperative stroke is relatively high;However,it is not consistent with foreign countries that the operation of urinary system is also relatively high in perioperative stroke.2.In the single factor analysis,the event group and the non-event group’s age,The history of stroke/TIA,History of atrial fibrillation were statistical differences;3.Advanced age and the history of stroke/TIA were confirmed the independent risk factor of patients with perioperative stroke in the Elderly.