WiP Seminar: Dr. Alana Flexman & Jaycee Farmer

Alana Flexman, MD, MBA(C), FRCPC
Scientist, CHÉOS
Clinical Associate Professor, Department of Anesthesiology, Pharmacology and Therapeutics, UBC
Director of Research, Department of Anesthesiology, Providence Health Care

Jaycee Farmer, BSc
MSc Candidate, UBC Department of Anesthesiology, Pharmacology and Therapeutics & Department of Anesthesiology, St. Paul’s Hospital

Stroke after surgery: Characterizing outcome and management of an uncommon perioperative complication 

Perioperative stroke affects 0.1–2% of patients having surgery and full recovery is infrequent. Although the incidence of myocardial infarction and injury is decreasing, the risk of perioperative stroke increased nearly 50% between 2004 and 2013. Current evidence suggests that patients who experience a perioperative stroke do poorly, more so than those who have stroke outside the surgical context although this remains poorly characterized. Perioperative strokes are often recognized in a delayed fashion with less frequent intervention likely due to low awareness amongst providers and the residual effects of anesthesia and surgery, which likely results in poorer outcomes. Our research aims to understand predictors of outcome in this population to guide management and level of intervention, and identify potentially modifiable factors.

In this Work in Progress Seminar, we will provide an overview of the current evidence characterizing stroke after surgery, including gaps in knowledge. We will present our preliminary analysis of over 20,000 perioperative stroke patients in the National Surgical Quality Improvement Program database, a large, prospectively collected multicenter database of surgical patients. We will describe the characteristics and outcomes of those who experience a perioperative stroke, including mortality, complications, length of stay, and discharge to a non-home facility. We will focus on mediators of mortality risk such as anesthetic technique and repeat surgery. Finally, we will discuss next steps to externally validate our model and define differences in outcome between perioperative and non-perioperative stroke using linked population databases in B.C., including use of newer therapies such as endovascular thrombectomy.

Click here to register (required): https://ubc.zoom.us/meeting/register/u5Epfu6oqjwtHtHxC6uYT9bvVDLKXZuCdgQ8