<strong>Stroke As a Major Cause of Disability</strong>

According to a report from the World Health Organization [<a class="ref-link" href="https://www.intechopen.com/books/new-insight-into-cerebrovascular-diseases-an-updated-comprehensive-review/rehabilitation-strategies-and-key-related-mechanisms-involved-in-stroke-recovery#B1" data-ref-style="bibr">1</a>], approximately 15 million people experience a stroke each year globally, and stroke is the third leading cause of death after heart disease and cancer, and a major cause of disability. With the aging of the American population and as obesity increases, more strokes are occurring: strokes occur in more than 795,000 U.S. citizens per year and result in 140,000 deaths with 77% of them first-time.<a href="https://franklinpierce.edu/about/Showcase2020/Projects/TherapyStrokeRehab-Ostrander.pdf">[2]</a>

The American Heart Association and the American Stroke Association have issued new guidelines aimed at reducing the incidence of stroke. Identifying lifestyle as having had the biggest impact on preventing stroke, the new guidelines urge not smoking, maintaining a healthy weight, exercising and eating a diet rich in fruits and vegetables, and maintaining healthy levels of cholesterol and blood pressure.

<strong>Does Anyone Even Think About the Stroke Risk When Considering Surgery?</strong>

<span style="font-weight: 400;">People often choose surgery without understanding the risks or potential long-term results of the surgery. When considering surgery, people may think about the recovery time, the cost incurred, and the loss of work hours. They may even wonder if they really want an artificial joint and if they are up to dealing with the pain involved in the surgery. But does anyone think there may be a risk of stroke surrounding surgery? Strokes are a risk factor that is discussed when people face heart surgery, because of the possibility of blood clots during the bypass and all of the manipulation of blood vessels. But what about during other surgeries that are lower risk surgeries? Evidence does show that strokes occur in those without heart conditions too, and in people who are not considered high risk and to those who had no symptoms before surgery. In this article, we will present the findings from several research studies that investigate the perioperative stroke risk, because we want people to be educated and to fully explore their options before choosing an elective surgery. </span><span style="font-weight: 400;">Perioperative stroke refers to a stroke that occurs during surgery or within 30 days after surgery.</span><span style="font-weight: 400;"> </span>

<b>What Does the Research Say About Strokes and Surgery?</b>

<span style="font-weight: 400;">An article in the journal, “Lancet” <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31795-7/fulltext">[3]</a> investigated the occurrence of strokes in people who did not have stroke symptoms before the surgery. They also looked into the rate of cognitive decline after surgery. The study included 12 academic centers and 1114 people over a three year period. What were the results? The researchers found that 78 people, or 7%, had a stroke.</span><span style="font-weight: 400;"> What about cognitive decline? A third of those who did not have a stroke was shown to have cognitive decline. So, what does all that mean? There is a risk of stroke and problems with deteriorating brain function in 1 out of 14 people who have elective surgery, even if they were not high risk, to begin with. </span>

<span style="font-weight: 400;">Stroke really is a possible complication in surgeries that don’t involve the heart or neurological system. The risk increases in people over 65. Plus, the risk of death is higher for those who have a perioperative stroke. In the journal, “Anesthesiology,”<a href="https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1933494">[4]</a> the researchers investigated specific things that increased the risk of stroke from surgery in the non-cardiac and non-neurological cases. They looked at all different types of surgeries, including hip replacements, biopsies, hernia repair, arthroscopies, and knee repairs. This study found three types of surgeries with the highest risk, which included hip replacement, removal of part of the intestine, and removal of part of the lung.  Other specifics that increase risk included older age, kidney disease, COPD, tobacco use, and elevated blood pressure. For those who do experience a perioperative stroke, the chance of dying within 30 days of the surgery is increased by 8 times. In this particular study, 229 of 173,028 people had a stroke during non-cardiac and non-neurologic surgery.</span>

<b>What about surgery and anesthesia?</b>

<span style="font-weight: 400;">Another study in the journal “Anesthesia”<a href="https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1946026">[5]</a> took a look at stroke risk from surgery and anesthesia. They studied 1,455 stroke occurrences over a 25 year period, excluding those with cardiac, vascular, neurologic, and other high-risk conditions. What did they find? They were actually surprised to find out that surgery and anesthesia themselves were a significant risk of stroke, especially considering they left out the high-risk folks with cardiac, vascular, or neurologic problems. </span>

<span style="font-weight: 400;">One more journal actually said the reason for stroke after surgery is “clear and highly predictable: </span><b>surgery.</b><span style="font-weight: 400;">”</span><span style="font-weight: 400;"> <a href="https://pubmed.ncbi.nlm.nih.gov/24978064/">[6]</a>Surgery is necessary sometimes. But when there are alternatives to surgery, these options should be sought out. Keep in mind that surgery is often recommended on the basis of an MRI finding. However, these findings may not even be the cause of the pain. We encourage you to find a practitioner who will evaluate you well, and do a complete history and examination in order to make a proper diagnosis. Frequently, structural injuries, such as ligament and tendon injuries, are the underlying source of pain. Surgery often cuts through and removes some of these structures, which actually accelerates the arthritic process, and puts you in line for more surgery.</span>

<span style="font-weight: 400;">Fortunately, there is an alternative to surgery that is highly successful! Regenerative Orthopedics can be sought as a first-line, conservative treatment that can be tried before surgery because it is effective at relieving pain and allowing patients to return quickly to the sports, work, and activities they love. It is also an excellent choice for repair of joint injuries and painful musculoskeletal joint conditions while avoiding the risk of stroke and other risks of elective surgery. If you have already had surgery, but continue to experience joint pain, Regenerative Orthopedics, like Stem Cell Therapy, PRP, and Prolotherapy is still an option for pain relief and return to function. When joint injuries are limiting your life, Regenerative Orthopedics can get you the results you want quickly, more safely, and at a dramatically lower cost than surgery.</span>

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1World Health Organization. The Atlas of Heart Disease and Stroke [Internet]. Available from: http://www.who.int/cardiovascular_diseases/resources/atlas/en/[Accessed: 21 Jun 2020]

2Abbott, Taylor, and Mary Elizabeth Ostrander. "What therapies are most beneficial for stroke rehabilitation?."

<span style="font-weight: 400;">3Perioperative covert stroke in patients undergoing non-cardiac surgery.</span><i><span style="font-weight: 400;"> Lancet,</span></i><span style="font-weight: 400;"> 2019. Doi.org/10.1016/SO140-6736(19)31795-7.</span>

<span style="font-weight: 400;">4Mashour GA, Shanks AM, Kheterpal S.Perioperative stroke, and associated mortality after noncardiac, non-neurologic surgery.</span> <i><span style="font-weight: 400;">Anesthesiology.</span></i><span style="font-weight: 400;"> 2011; </span>114<span style="font-weight: 400;">: 1289-1296.</span>

<span style="font-weight: 400;">5G</span><span style="font-weight: 400;">ilbert Y. Wong, M.D.</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">David O. Warner, M.D.</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">Darrell R. Schroeder, M.S.</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">Kenneth P. Offord, M.S.</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">Mark A. Warner, M.D.</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">et al. </span><span style="font-weight: 400;">Risk of surgery and anesthesia for ischemic stroke. </span><i><span style="font-weight: 400;">Anesthesiology</span></i><span style="font-weight: 400;">. 2000; 92: 425.</span>

<span style="font-weight: 400;">6Mashour, George A. MD, Ph.D.</span><span style="font-weight: 400;">*</span><span style="font-weight: 400;">; Moore, Laurel E. MD; Lele, Abhijit V. MD; Robicsek, Steven A. MD; Gelb, Adrian W. MBChB</span><span style="font-weight: 400;">. </span><span style="font-weight: 400;">Perioperative care of patients at high risk for stroke during or after non-cardiac, non-neurologic surgery: A consensus statement from the Society for Neuroscience in Anesthesiology and Critical Care. </span><span style="font-weight: 400;"> </span><i><span style="font-weight: 400;">Journal of Neurosurgical Anesthesiology.</span></i> <span style="font-weight: 400;"> 2014; 26(4): 273–285</span><span style="font-weight: 400;">.</span>