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Long-Term Outcomes for Patients With Stroke After Coronary and Valve Surgery
Ching-Chang Chen1, Tien-Hsing Chen2, Po-Hsun Tu1
1Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
Insights
Postoperative stroke after cardiac surgery significantly increases mortality. Neurosurgical intervention for severe stroke yields poor long-term outcomes, necessitating informed patient consent.
Area of Science:
- Cardiology
- Neurosurgery
- Public Health
Background:
- Postoperative stroke is a severe complication following cardiac surgery.
- Neurosurgical interventions may be necessary for life-threatening stroke complications.
- This study investigates long-term outcomes of stroke after cardiac surgery.
Purpose of the Study:
- To analyze the long-term medical and surgical outcomes of patients experiencing stroke after cardiac surgery.
- To compare outcomes among patients with no stroke, stroke with medical treatment, and stroke with neurosurgical treatment.
- To identify risk factors for mortality in the neurosurgical subgroup.
Main Methods:
- Retrospective, nationwide, population-based study design.
- Inclusion of 67,051 patients undergoing first-time cardiac surgery.
- Analysis of all-cause mortality, recurrent stroke, and readmission rates across subgroups.
Main Results:
- 2.6% of patients experienced postoperative stroke, with a 5-year mortality rate of 49.1%.
- Neurosurgical intervention for stroke resulted in a 65.1% 5-year mortality rate.
- Age was identified as a significant risk factor for mortality in the neurosurgical subgroup.
Conclusions:
- Postoperative stroke is associated with high mortality and poor long-term prognosis.
- Neurosurgical procedures for severe stroke after cardiac surgery are linked to particularly adverse outcomes.
- Informed consent regarding high mortality and poor outcomes is crucial for patients considering neurosurgery.
Background:
Postoperative stroke is one of the most devastating complications of cardiac surgery. When life-threatening situations such as large infarction and hemorrhage occur, neurosurgical procedures may be performed. In this study, we analyzed the long-term medical and surgical outcomes of stroke after cardiac surgery.
Methods:
We conducted a retrospective, nationwide, population-based study. All enrolled patients underwent first-time cardiac surgery and were further divided into the subgroups of nonstroke, stroke with medical treatment, and stroke with neurosurgical treatment. All-cause mortality, recurrent stroke, and readmission were analyzed.
Results:
We included 67,051 patients in this study. Patients with postoperative stroke (2.6%, n = 1,731) exhibited an in-hospital mortality rate of 12.3% (n = 213) and a 5-year mortality rate of 49.1% (n = 850). Unprecedentedly, the 83 patients who underwent neurosurgical procedures exhibited an in-hospital mortality of 16.9%; this rate increased to 65.1% at the 5-year follow-up. This neurosurgical subgroup exhibited the highest rate of long-term mortality (p < 0.001). In the neurosurgical subgroup, age was the risk factor for all-cause mortality (hazard ratio, 2.60; 95% confidence interval, 1.60-4.24; p < 0.001).
Conclusions:
Postoperative stroke often leads to high mortality and poor long-term outcomes. Patients who experienced a severe stroke and underwent neurosurgical procedures also exhibited poor outcomes. Patients and their families should be informed of relatively high mortality and poor long-term outcomes before neurosurgical operation.
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