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Published on: March 27, 2018
Timing of stroke after cardiopulmonary bypass determines mortality
Turner C Lisle1, Kevin M Barrett, Leo M Gazoni
1Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. tl4b@virginia.edu
Insights
Early stroke after cardiopulmonary bypass (CPB) significantly increases the risk of death and the need for rehabilitation. Identifying and preventing early postoperative strokes is crucial for improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Stroke is a significant complication following cardiopulmonary bypass (CPB).
- Understanding the timing of stroke events post-CPB is critical for predicting outcomes.
Purpose of the Study:
- To determine if the timing of stroke events after CPB predicts stroke-related mortality.
- To assess if stroke timing predicts rehabilitation needs at hospital discharge.
Main Methods:
- A retrospective review of 7201 cardiac surgical patients over 10 years identified 202 strokes.
- Postoperative strokes were classified as early (<= 24 hours) or late (> 24 hours).
- Logistic regression analysis evaluated the relationship between stroke timing and discharge status, adjusting for covariates.
Main Results:
- The incidence of stroke after CPB was 2.8%.
- Early postoperative strokes (within 24 hours) were independently associated with higher stroke-related death (OR, 9.16; p < 0.0001).
- Early stroke also correlated with increased rehabilitation needs among survivors (p < 0.001).
Conclusions:
- Early stroke following CPB is a strong independent predictor of increased mortality.
- Patients experiencing early stroke require greater rehabilitation support upon discharge.
- Implementing neuroprotective strategies to mitigate early postoperative strokes may improve survival and reduce neurological disability.
Background:
Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge.
Methods:
We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (< or = 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors.
Results:
The stroke incidence was 2.8%. Postoperative strokes occurred within 24 hours in 22.8% (46 of 202) and after 24 hours in 77.2% (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001).
Conclusions:
Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.
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