Nonischemic Postoperative Seizure Does Not Increase Mortality After Cardiac Surgery

Postoperative seizure (PS) is an infrequent, yet distressing, complication after cardiac surgery. We wished to determine the prognostic significance of these complicated neurologic events.

The Weill Cornell Medical College Department of Cardiothoracic Surgery database and the New York State Department of Health Database were reviewed to identify all patients having PS after cardiac surgery between January 1, 2008, and December 31, 2011.

During the study period 3,518 patients had cardiac surgery at the index hospital; 45 of them had PS (1.27%). Overall, patients having PS had a significant increase in 30-day mortality when compared with those not having PS (6.7% versus 1.5%; p < 0.006). The incidence of major postoperative complications in those having PS was also significantly higher (53.3% versus 10.5%; p < 0.001). However, logistic regression failed to demonstrate PS as an independent predictor of perioperative mortality. When the PS group was further stratified by the presence or absence of cerebrovascular accident, those having both PS and cerebrovascular accident had substantially increased morbidity and mortality (mortality, 0 of 33 versus 3 of 12; major morbidity, 12 of 12 versus 12 of 33; p < 0.01 for both), whereas PS patients without cerebrovascular accident did not have greater risk for either major adverse events or mortality.

When PS is associated with acute cerebrovascular accident, a significant increase in postoperative morbidity and mortality can be expected. However, in those with isolated PS (without evidence of new neurologic injury), perioperative mortality and morbidity are comparable to those without any neurologic complications.