In the original article, there was a mistake in Figure 1 as published. “ASA physical status V” should be “ASA physical status ≥ IV.” In addition the corresponding n number was give as 391, but should be 1,091. In addition, the corresponding n number for “Missing data for any confounder” was 3,144 but should be 2,444. The revised Figure 1 appears below.
Figure 1.
Study profile. ASA, American Society of Anesthesiologists; PSM, propensity score matching.
There was also an error in Materials and methods, “Inclusion and exclusion criteria,” Paragraph 1. “Patients who presented with an American Society of Anesthesiologists (ASA) classification of V” should be “Patients who presented with an American Society of Anesthesiologists (ASA) classification of ≥IV.” The corrected paragraph appears below:
“Patients who underwent non-cardiac surgery between January 2008 and August 2019 at Chinese PLA General Hospital were initially screened from a perioperative retrospective database. The inclusion criteria were as follows: (1) aged 65 yr or older; (2) underwent non-cardiac surgery; (3) received general anesthesia; and (4) were with duration of surgery > 60 min. Patients who presented with an American Society of Anesthesiologists (ASA) classification of ≥IV, were performed under regional anesthesia, or had missing clinical data were excluded. Among patients who underwent multiple surgeries during the study period, only the first eligible surgery was considered. A flow diagram of the patient selection process is displayed in Figure 1.” In the original article, there was also a mistake in the Abstract, “Conclusion” as published. The Abstract conclusion stated, “after non-cardiac surgery in elderly older patients.” This should be “after non-cardiac surgery in older patients.” The corrected paragraph appears below:
“Conclusion: Preoperative SII, which includes neutrophil, platelet, and lymphocyte counts obtained from routine blood analysis, was a potential prognostic biomarker for predicting perioperative ischemic stroke after non-cardiac surgery in older patients. An elevated SII, based on an optimal cut-off value of 583, was an independent risk factor for perioperative ischemic stroke.”
In the original article, there was also an error in Table 1 and Supplementary Tables 2–4. The covariates previously stated “Class III and IV” and “Arterial fibrillation.” The corrected covariates are “Class III” and “Atrial fibrillation or VHD.” The corrected Table 1 appears below. The corrected Supplementary Tables 2–4 appear in the Supplementary Material of the original article.
Table 1.
Baseline characteristics of unadjusted sample and propensity score-matched sample (patients from 2008–2019).
| Characteristic |
Unadjusted sample (n = 40,670) |
PSM adjusted (1:1) (n = 21,652) |
||||||
|---|---|---|---|---|---|---|---|---|
| SII < 583 | SII ≥583 | P-value | SMD | SII < 583 | SII ≥583 | P-value | SMD | |
| (n = 29,060) | (n = 11,610) | (n = 10,826) | (n = 10,826) | |||||
| Demographics | ||||||||
| Age, y† | 70.0 (67.0,73.0) | 70.0 (67.0,75.0) | 0.126 | 0.152 | 70.0 (67.0,74.0) | 70.0 (67.0,74.0) | 0.556 | 0.004 |
| Female (%)† | 13651 (47.0) | 4683 (40.3) | < 0.001 | 0.134 | 4458 (41.2) | 4427 (40.9) | 0.679 | 0.006 |
| BMI, kg/m2† | 24.5 (22.3,26.9) | 23.7 (21.5,26.0) | 0.089 | 0.233 | 24.0 (21.6,26.4) | 23.8 (21.5,26.0) | 0.136 | 0.097 |
| ASA classification (%) † | ||||||||
| Class I | 741 (2.5) | 234 (2.0) | < 0.001 | 0.197 | 261 (2.4) | 230 (2.1) | 0.356 | 0.022 |
| Class II | 22885 (78.8) | 8255 (71.1) | 7826 (72.3) | 7793 (72.0) | ||||
| Class III | 5434 (18.7) | 3121 (26.9) | 2739 (25.3) | 2803 (25.9) | ||||
| Previous medical history | ||||||||
| Hypertension (%)† | 10874 (37.4) | 4685 (40.4) | < 0.001 | 0.060 | 4211 (38.9) | 4360 (40.3) | 0.257 | 0.021 |
| Diabetes mellitus (%)† | 6096 (21.0) | 2756 (23.7) | < 0.001 | 0.066 | 2436 (22.5) | 2554 (23.6) | 0.178 | 0.076 |
| Prior ischemic stroke (%)† | 1552 (5.3) | 847 (7.3) | < 0.001 | 0.080 | 682 (6.3) | 765 (7.1) | 0.228 | 0.068 |
| Coronary heart disease (%)† | 2879 (9.9) | 1231 (10.6) | 0.037 | 0.023 | 1070 (9.9) | 1146(10.6) | 0.093 | 0.023 |
| Atrial fibrillation or VHD (%)† | 454 (1.6) | 202 (1.7) | 0.215 | 0.014 | 165 (1.5) | 180 (1.7) | 0.447 | 0.011 |
| Peripheral vascular disease (%)† | 1996 (6.9) | 892 (7.7) | 0.004 | 0.031 | 811 (7.5) | 802 (7.4) | 0.836 | 0.003 |
| Renal dysfunction (%)†* | 338 (1.2) | 234 (2.0) | < 0.001 | 0.068 | 191 (1.8) | 205 (1.9) | 0.456 | 0.047 |
| β-blockers medication (%)† | 2051 (7.1) | 999 (8.6) | < 0.001 | 0.058 | 869 (8.2) | 931 (8.6) | 0.167 | 0.065 |
| Aspirin medication (%)† | 2553 (8.8) | 1174 (10.1) | < 0.001 | 0.045 | 1024 (9.5) | 1086 (10.0) | 0.293 | 0.043 |
| Preoperative laboratory data | ||||||||
| Hemoglobin, g/L† | 132.0 (122.0,142.0) | 125.0 (111.0,138.0) | < 0.001 | 0.437 | 128.0 (114.0,140.0) | 127.0 (113.0,139.0) | 0.156 | 0.083 |
| Albumin, g/L† | 40.3 (38.1,42.5) | 40.5 (38.2,43.0) | 0.223 | 0.481 | 38.9 (36.2,41.4) | 38.8 (36.0,41.7) | 0.837 | 0.005 |
| Total bilirubin, μmol/L† | 10.9 (8.4,14.2) | 10.6 (7.8,15.6) | < 0.001 | 0.291 | 10.7 (8.3,14.6) | 10.6 (7.7,14.9) | 0.202 | 0.093 |
| Prothrombin time, s† | 13.1 (12.6,13.6) | 13.2 (12.7,13.9) | 0.123 | 0.176 | 13.2 (12.7,13.8) | 13.2 (12.7,13.8) | 0.600 | 0.028 |
| Surgical and anesthetic factors | ||||||||
| Preoperative MAP, mmHg | 95.7 (88.7,103.0) | 95.0 (87.3,102.3) | 0.098 | 0.070 | 95.0 (87.3,102.3) | 95.0 (88.0,102.7) | 0.169 | 0.024 |
| Surgical procedures (%) | ||||||||
| Trauma surgery | 433 (1.5) | 602 (5.2) | < 0.001 | 0.352 | 404 (3.7) | 353 (3.3) | ||
| Spine | 2751 (9.5) | 715 (6.2) | 758 (7.0) | 711 (6.6) | 0.258 | 0.041 | ||
| Intra-abdominal surgery | 9652 (33.2) | 5159 (44.4) | 4688 (43.3) | 4690 (43.3) | ||||
| Joint arthroplasty | 3726 (12.8) | 1031 (8.9) | 987 (9.1) | 1027 (9.5) | ||||
| Urologic or gynecologic | 3972 (13.7) | 1219 (10.5) | 1138 (10.6) | 1209 (11.1) | ||||
| Neurosurgery | 1380 (4.7) | 523 (4.5) | 516 (4.8) | 515 (4.8) | ||||
| Thoracic or vascular | 3362 (11.6) | 1225 (10.5) | 1172 (10.8) | 1199 (11.1) | ||||
| Other (plastic surgery, etc.) | 3784 (13.0) | 1136 (9.8) | 1163 (10.7) | 1122 (10.3) | ||||
| Duration of procedures, min | 155.0 (110.0,215.0) | 170.0 (120.0.0,235.0) | < 0.001 | 0.162 | 168.0 (118.0,231.0) | 170.0 (120.0,235.0) | 0.356 | 0.076 |
| Estimated blood loss, mL | 100.0 (50.0,200.0) | 150.0 (50.0,300.0) | < 0.001 | 0.083 | 140.0 (90.0,280.0) | 145.7 (100.0,300.0) | 0.167 | 0.096 |
| MAP ≤ 65 mmHg (%) | 12600 (43.4) | 5749 (49.5) | < 0.001 | 0.070 | 5125 (47.3) | 5285 (48.8) | 0.234 | 0.072 |
| Crystalloid infusion, ml/kg/h | 8.6 (6.5,11.4) | 8.9 (6.6,11.8) | 0.167 | 0.073 | 8.8 (6.6,11.7) | 8.8 (6.5,11.7) | 0.845 | 0.006 |
| Colloid infusion, ml/kg/h | 2.9 (1.3,4.3) | 3.1 (1.8,4.5) | < 0.001 | 0.123 | 3.0 (1.6,4.4) | 3.0 (1.8,4.5) | 0.111 | 0.066 |
| Blood transfusion (%) | 3902 (13.4) | 2322 (20.0) | < 0.001 | 0.177 | 1998 (18.5) | 2082 (19.2) | 0.189 | 0.052 |
| NSAIDs (%) | 20502 (70.6) | 8366 (72.1) | 0.003 | 0.033 | 7667 (70.8) | 7709 (71.2) | 0.539 | 0.009 |
| Glucocorticoid (%) | 23749 (81.7) | 9557 (82.3) | 0.165 | 0.015 | 8905 (82.3) | 8932 (82.5) | 0.643 | 0.007 |
| Opioid dose, mg‡ | 120.0 (9.0,150.0) | 135.0 (105.0,165.0) | < 0.001 | 0.081 | 135.0 (100.0,150.0) | 135.0 (105.0,165.0) | 0.256 | 0.047 |
| Volatile anesthetic (%) | 27098 (93.2) | 10819 (93.2) | 0.840 | 0.002 | 10097 (93.3) | 10110 (93.4) | 0.744 | 0.005 |
| Preoperative NLR | ||||||||
| < 3 | 27796 (95.7) | 4098 (35.3) | < 0.001 | 1.643 | 10215 (94.4) | 3951 (36.5) | < 0.001 | 1.583 |
| ≥3 | 1264 (4.3) | 7512 (64.7) | 611 (5.6) | 6875 (63.5) | ||||
| Preoperative PLR | ||||||||
| < 119 | 18897 (65.0) | 959 (8.3) | < 0.001 | 1.458 | 6821 (63.0) | 914 (8.4) | < 0.001 | 1.385 |
| ≥119 | 10163 (35.0) | 10651 (91.7) | 4005 (37.0) | 9912 (91.6) | ||||
| Perioperative ischemic stroke (%) | 126 (0.434) | 111 (0.956) | < 0.001 | 0.856 | 49 (0.453) | 107 (0.988) | < 0.001 | 0.939 |
The data are presented as the median (inter-quartile range), mean (standard deviation) or n (%).
Creatinine > 177 μm/l.
Variables included in the propensity score.
Including those prescribed intraoperatively and postoperatively (until 7 days after surgery).
SII, systemic-immune-inflammation index; PSM, propensity score matching; SMD, standardized mean difference; BMI, body mass index; ASA, American Society of Anesthesiologists; VHD, valvular heart disease; MAP, mean arterial pressure; NSAIDs, non-steroid anti-inflammatory drugs; NLR, neutrophil-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.
In the original article there was also an error in Materials and methods, “Clinical outcome.” The definition of perioperative ischemic stroke was incomplete. The following information was not provided: “Diagnoses of stroke are confirmed by a combination of neuroimaging and clinical evidence of cerebrovascular ischemia during hospital stay.” The corrected paragraph appears below:
“The primary outcome of interest was perioperative ischemic stroke, defined as an episode of neurological dysfunction, such as motor, sensory, or cognitive dysfunction, caused by focal cerebral, spinal, or retinal infarction within 30 postoperative days (Sacco et al., 2013). Diagnoses of stroke are confirmed by a combination of neuroimaging and clinical evidence of cerebrovascular ischemia during hospital stay. In our study, perioperative ischemic stroke patients were identified if discharge records included at least 1 ICD-9-CM/ICD-10-CM diagnosis code for stroke (Supplementary Table 1).”
We apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.
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References
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