Postoperative stroke related to cardiac surgery in octogenarians

Demographics of cardiac surgery patients are changing, with an increase in aged patients. We aim to identify risk factors, mortality, morbidity and increasing postoperative costs due to postoperative stroke in octogenarians following cardiopulmonary bypass (CPB).

A total of 418 consecutive patients older than 80 years (Group A) who underwent cardiac surgery with CPB between 2000 and 2012 were matched according to gender, surgical procedure and comorbidities with 426 younger patients (Group B). Risk factors for postoperative stroke were retrospectively evaluated.

We identified postoperative stroke in 4.1% of patients in Group A and in 3.5% in Group B (P = 0.65). Early stroke was diagnosed in 13 patients in Group A (76.5%) and 10 patients in Group B (66.7%) (P = 0.53). In multivariate analysis, preoperative anaemia (P = 0.033; odds ratio [OR]: 3.84; 95% CI: 1.11-13.28) was the only risk factor associated with postoperative stroke in Group A. In Group B, preoperative peripheral vascular disease (P = 0.0003; OR: 7.30; 95% CI: 2.47-21.55) and postoperative atrial fibrillation (P = 0.0134; OR: 4.05; 95% CI: 1.33-12.31) were identified as risk factors.

Incidence of postoperative stroke after CPB was not significantly higher in our octogenarian population. Although in younger patients peripheral vascular disease and cardiac rhythm disturbances were significant risk factors, it seems that factors related to intraoperative brain oxygenation (secondary to preoperative anaemia) are the most critical determinant of stroke in the elderly.