Risk for postoperative adverse cardiovascular events was especially high during the first 9 months after stroke. If possible, you should wait at least 9 months and preferably 12 months after an ischemic stroke to undergo elective non cardiac surgery.
Stroke is a known risk factor for adverse perioperative outcomes in patients undergoing noncardiac surgery. Whether this relation is time dependent is unclear.
Researchers in Denmark examined a nationwide cohort of adult patients who underwent elective noncardiac surgery between 2005 and 2011. Of the almost half a million patients who underwent noncardiac surgery, 1.5% had histories of stroke (those with prior transient ischemic attacks or hemorrhagic stroke were excluded). Compared with patients who never experienced strokes, those who had prior strokes had higher risk for major adverse cardiovascular events (MACE: a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular-related death):
- Stroke within 3 months before surgery: odds ratio, 14.2
- Stroke between 3 and 6 months prior: OR, 4.9
- Stroke between 6 and 12 months prior: OR, 3.0
- Stroke ≥12 months prior: OR, 2.5
A similar pattern in risk was seen for 30-day mortality. Risk for MACE and all-cause mortality leveled off at 9 months.
Jørgensen ME et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014 Jul 16; 312:269. Link.