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Published on: January 18, 2018
Independent Predictors of Perioperative Stroke-Related Mortality after Cardiac Surgery
Bansri M Patel1, Nathan J Reinert1, Khaled Al-Robaidi1
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Perioperative stroke after cardiac surgery is a major cause of death. Carotid stenosis, in-hospital stroke, prior stroke history, and advanced age are key predictors of stroke-related mortality.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Public Health
Background:
- Perioperative stroke is a significant complication of cardiac surgery, leading to high morbidity and mortality.
- Risk factors for stroke-related mortality after cardiac surgery are not well-defined.
- This study aimed to identify independent predictors of perioperative stroke-related mortality.
Purpose of the Study:
- Identify independent predictors of perioperative stroke-related mortality following cardiac surgery.
- Utilize the Pennsylvania Health Care Cost Containment Council (PHC4) database for cause of death analysis.
- Inform strategies to mitigate stroke risk in cardiac surgery patients.
Main Methods:
- Retrospective analysis of 3345 patients undergoing cardiac surgery (2012-2014).
- Identification of perioperative (30-day) stroke-related mortality using ICD-10-CM codes.
- Fisher's exact test and multivariate analysis to determine independent predictors.
Main Results:
- Carotid stenosis independently predicted stroke-related mortality (aOR 4.9).
- In-hospital stroke (aOR 108.8), history of stroke (aOR 17.1), and age ≥ 80 (aOR 4.9) were also significant predictors.
- These findings were adjusted for all other variables via multivariate analysis.
Conclusions:
- Carotid stenosis is identified as a novel, independent predictor of perioperative stroke-related mortality after cardiac surgery.
- Understanding these risk factors can improve preoperative screening, intraoperative monitoring, and treatment efficacy.
- Interventions targeting identified risk factors may reduce stroke-related mortality in this patient population.
Background And Purpose:
Perioperative stroke remains a devastating complication after cardiac surgery and is associated with significant morbidity and mortality. Despite the significant contribution of stroke to perioperative mortality, risk factors for perioperative stroke-related mortality have not been well characterized. Our aim was to identify independent predictors of perioperative stroke-related mortality after cardiac surgery, using the Pennsylvania Health Care Cost Containment Council (PHC4) database which provides information on cause of death.
Methods:
We retrospectively examined patient medical records from 2012 to 2014 of 3345 patients (ages 18-99) who underwent a cardiac surgical procedure and suffered perioperative (30-day) mortality. Perioperative stroke-related mortality was identified by International Classification of Diseases, Tenth Revision, Clinical Modification cause of death codes. We performed Fisher's exact test and multivariate analysis to identify comorbidities that independently predict perioperative stroke-related mortality.
Results:
After controlling for all variables with multivariate analysis, we found that patients with carotid stenosis were 4.9 (adjusted odds ratio [aOR], 95% confidence interval [CI] 1.8-12.8) times more likely to die from a stroke than from other causes, when compared to patients without carotid stenosis. Other independent predictors of perioperative stroke-related mortality included in-hospital stroke (aOR 108.8, 95%CI 48.2-245.9), history of stroke (aOR 17.1, 95%CI 3.3-88.4), and age ≥ 80 (aOR 4.9, 95%CI 2.1-11.2).
Conclusions:
This is the first study to establish carotid stenosis, among other comorbidities, as an independent predictor of perioperative stroke-related mortality after cardiac surgery. Understanding risk factors for mortality from stroke will help enhance the efficacy of preoperative screening, intraoperative neurophysiological monitoring, and potential treatments for stroke. Interventions to manage carotid stenosis and other identified risk factors prior to, during, or immediately after surgery may have the potential to reduce perioperative stroke-related mortality after cardiac surgery.
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