Current clinical guidelines used to determine when patients can safely undergo surgery following a stroke may be too conservative and could be delaying important care for cancer and other “semi-urgent” conditions, a new study has found.
In 2021, the American Heart Association and American Stroke Association issued a joint scientific statement that individuals should wait at least six months, and perhaps as long as nine months, before undergoing non-urgent surgery, to reduce the risk of a recurrent stroke. Those guidelines were based in part on a Demark study of 481,183 stroke patients, which found the risk of a recurrent stroke was highest within the first three months after surgery and leveled off after nine months.
New research published in JAMA Surgery, however, says that the six- to nine-month time period for delaying surgery following a stroke may be unnecessary.
The study identified limitations with utilizing data from Europe in the United States. Researchers noted that the U.S. population has significantly higher risk factors for stroke, such as higher rates for heart disease, diabetes and hypertension and lower life expectancy than European nations.
The investigative team was led by Laurent Glance, M.D., a professor in the Departments of Anesthesiology and Perioperative Medicine and Public Health Sciences at the University of Rochester Medical Center.
To gain a more accurate picture of the U.S. situation, Glance and his team examined the health records of more than 5.8 million people 66 years of age or older who underwent an elective non-neurologic, non-cardiac surgery between January 2013 and November 2018, using a Medicare database.
While the researchers found significantly elevated stroke risk for individuals undergoing surgery within 30 days of a stroke, the risk of recurrent stroke leveled off after 90 days following surgery in the U.S. study.
“The findings open the door to efforts to better understand and stratify and mitigate risk for perioperative stroke, while allowing necessary care to move forward,” according to a University of Rochester news release.
“Shortening the recommended delay between a stroke and surgery could have significant implications for care, especially involving procedures that are semi-urgent, such as cancer surgery,” the release added.
