Patients undergoing surgery with a history of migraine have an increased risk of perioperative ischemic stroke within 30 days as well as an increased hospital readmission rate, according to a study published in BMJ.
Fanny P Timm, from the Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues, identified patients who had surgery under general anesthesia with mechanical ventilation between January 2007 and August 2014. There were 124,588 surgical patients included (54.5% women), with a mean age of 52.6 years. History of migraine and migraine aura status was determined on the basis of ICD-9 diagnosis codes. The authors hypothesized that the diagnosis of migraine would increase the risk of perioperative ischemic stroke in a large cohort of surgical patients.
The primary outcome was stroke within 30 days after surgery. Medical records of perioperative stroke were reviewed on the basis of brain scan reports, acute stroke and neurology consultation notes, and discharge summaries. The secondary outcome was hospital readmission within 30 days of discharge, defined as an in-hospital admission to the tertiary care facility or any other affiliated hospital.
Among the patients included, 771 (0.6%) perioperative ischemic strokes occurred. Vascular surgery had the highest rate of perioperative ischemic stroke (4.0%), followed by cardiac (3.5%) and neurosurgical (2.4%) procedures. Of all patients with perioperative ischemic stroke, 89 (11.5%) had a diagnostic code of migraine. Of these, 18 (2.3%) had migraine with aura and 71 (9.2%) had migraine without aura.
Patients with migraine had an increased risk for perioperative ischemic stroke compared with patients without migraine (odds ratio [OR], 1.75). The risk of perioperative ischemic stroke was higher for migraine with aura (OR, 2.61) but was also apparent for migraine without aura (OR, 1.62), compared with surgical patients without migraine.
In total, 10,088 patients in the study sample were readmitted to the hospital within 30 days. The 30-day hospital readmission rate was higher for patients with migraine than for those with no migraine (OR, 1.31). Both migraine with aura and migraine without aura were associated with a higher risk of 30-day hospital readmission compared with patients without migraine.
“Migraine represents an important risk marker for perioperative ischemic stroke among patients with a relatively low risk of ischemic stroke,” stated the authors. “Understanding this risk period offers unique opportunities to study ischemic stroke in migraine and might result in treatment considerations for patients at risk who are not undergoing surgical intervention.”
- Timm FP, Houle TT, Grabitz SD, et al. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study. BMJ. January 2017. doi: 10.1136/bmj.i6635.