Knowledge and perceptions about perioperative stroke: a cross-sectional survey of patients scheduled for non-neurologic
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REPORTS OF ORIGINAL INVESTIGATIONS
Knowledge and perceptions about perioperative stroke: a crosssectional survey of patients scheduled for non-neurologic and noncardiac surgery Les connaissances et perceptions sur l’accident vasculaire ce´re´bral pe´riope´ratoire : un sondage transversal de patients devant subir une chirurgie non neurologique et non cardiaque Taren Roughead, MD . Jason Chui, MBChB . Adrian W. Gelb, MBChB . Lingzhong Meng, MD . Darreul Sewell, MBChB . Alana M. Flexman, MD Received: 2 February 2019 / Revised: 27 June 2019 / Accepted: 1 July 2019 Ó Canadian Anesthesiologists’ Society 2019
Abstract Purpose Perioperative stroke is associated with significant morbidity and mortality yet patients may not be aware of their risk or receive appropriate counselling. Our objectives were to 1) compare patient’s perceived vs calculated risk of stroke; 2) determine level of worry; and 3) assess prior discussion about perioperative stroke risk amongst elective patients undergoing non-cardiac, nonneurologic surgery. Methods Over a consecutive four-week period, surveys were distributed at two pre-anesthetic clinics to adult patients scheduled for non-cardiac, non-neurologic surgery. The survey included questions about demographics, perioperative stroke risk factors, patient
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01474-w) contains supplementary material, which is available to authorized users.
perception of their quantitative and qualitative stroke risk, level of worry about stroke, and risk discussions. We identified independent predictors of risk underestimation amongst medium- and high-risk patients. Results Six hundred patients completed the survey (response rate 78%). Of these, 479, 104, and 15 patients were classified as low-, medium-, and high-risk, respectively (with two patients missing this data point). Most medium- (86%) and high-risk (80%) patients did not identify their elevated risk. Amongst medium- and high-risk patients, independent predictors of risk underestimation were lower education and absence of kidney disease. Medium- and high-risk patients were more worried than low-risk patients about perioperative stroke (median [interquartile range] visual analogue scale score 2 [0.5– 4] vs 1 [0–2], P = 0.001). Fewer than half of patients had discussed perioperative stroke previously (40%, 23%, and
T. Roughead, MD Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
D. Sewell, MBChB Department of Neuroanesthesia, National Hospital of Neurology and Neurosurgery, University College London Hospitals, London, UK
J. Chui, MBChB Department of Anesthesia & Perioperative Medicine, University of Western Ontario, London, ON, Canada
A. M. Flexman, MD (&) Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected]
A. W. Gelb, MBChB Department of Anesthesia and Perioperative Care, University of Califor
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