Can Surgery Cause a Stroke?

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Updated April 08, 2015.

Written or reviewed by a board-certified physician. See's Medical Review Board.

Does having surgery increase your risk of having a stroke? The answer is sometimes. That is one of the reasons surgery - especially elective surgery - has to be approached carefully if you have already had a stroke or if you are at risk of stroke. Your surgeon will discuss the risks of surgery with you. All surgery has risks. When an undesirable event such as a stroke occurs, there is usually not any preventable explanation.


Risks of Surgery


Surgery itself carries a risk. The body often responds to surgical incisions and anesthesia by alterations in blood pressure, heart function, blood sugar and blood clot formation that can increase the risk of a stroke. However, in some serious medical conditions such as cancer, heart disease and blood vessel disease- this increased risk of stroke during or after surgery is not as high as the risk of stroke from not having an operation.


Stopping Blood Thinners


Because surgery involves incisions, it is often recommend to discontinue taking blood thinners days to weeks prior to your scheduled procedure because all surgery causes bleeding. However, people who need to take blood thinners such as aspirin for stroke prevention are often at an increased risk of having dangerous blood clots during the time off of blood thinners. A recent issue of Advances in Surgery, published in September 2014, states that there is no simple solution for this dilemma and the risk of bleeding has to be weighed against the risk of blood clots.


Patients Who Have Had a Stroke Before Surgery


Studies show that stroke survivors have a higher chance of stroke and other medical complications after an operation than people who have never had a stroke. An article published in the November 2014 issue of the British Journal of Surgery reported on a large database of 1.4 million patients who had different surgical procedures. The patients who had a stroke within 2 years prior to surgery had a higher chance of stroke and other medical complications within a month after the procedure than the patients who had not experienced a stroke.


Silent Stroke


Silent stroke can occur after surgery. One study published in the Annals of Thoracic Surgery evaluated 19 patients who had surgery and did not show any signs of a stroke. However, 12 of those patients actually had evidence of small, silent strokes on brain imaging.  Thus, it appears that having surgery may increase the risk of strokes, even if patients do not have any of the obvious symptoms or effects of stroke.


What You Can do to Prevent a Stroke After Surgery


There are some steps you can take to decrease your chances of having a stroke after surgery. Follow pre-operative medication and pre-surgical instructions carefully. Stay healthy and avoid infections ahead of your scheduled procedure so that you don't go into elective surgery with colds or fevers that can prolong your recovery. Take it easy prior to your procedure because stress can increase your risk of stroke. Don't smoke. Don't drink alcohol. Do not use drugs. Take your medications as directed so that your blood pressure and blood sugar are well maintained in the weeks leading up to your surgery. Keep your appointments with your surgeon, your pre-operative testing and your primary care doctor so that any problems, such as heart or blood pressure irregularities, can be detected and managed on a well- planned out schedule instead of as an urgency.


Is it Someone’s Fault?


While a stroke is an unwanted outcome after surgery, it appears to be a risk. Therefore, when such a consequence happens, sometimes it is unavoidable and it isn’t someone’s fault. We always want to find out what went wrong. However, surgery puts an undeniable stress on the body. Despite the risks of stroke and other medical complications, sometimes surgery is the safest option.


Outcomes after surgery in patients with previous stroke, Liao CC, Chang PY, Yeh CC, Hu CJ, Wu CH, Chen TL, British Journal of Surgery, November 2014

Aspirin, clopidogrel, and the surgeon, Patel PA, Fleisher LA, Advances in Surgery, September 2014

Silent cerebral ischemia after thoracic endovascular aortic repair: a neuroimaging study, Kahlert P, Eggebrecht H, Jánosi RA, Hildebrandt HA, Plicht B, Tsagakis K, Moenninghoff C, Nensa F, Mummel P, Heusch G, Jakob HG, Forsting M, Erbel R,, Schlamann M, Annals of Thoracic surgery, July 2014
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