Related Experiment Video
Updated: Dec 7, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Timing of Recognition for Perioperative Strokes Following Cardiac Surgery
Beret Amundson1, Joseph Hormes2, Anna Katema2
1Emory University School of Medicine, Atlanta, GA, United States.
Insights
Delayed recognition of perioperative stroke after cardiac surgery is common. Factors like older age and history of stroke increase risk, necessitating frequent neurological monitoring post-surgery.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Perioperative stroke is a significant complication following cardiac surgery.
- Over half of these strokes are diagnosed after the first postoperative day, indicating delayed recognition.
Purpose of the Study:
- To identify preoperative and intraoperative factors associated with stroke after cardiac surgery.
- To understand factors contributing to the delayed diagnosis of perioperative stroke.
Main Methods:
- Retrospective review of patients undergoing coronary artery bypass grafting or isolated valve surgery (January 2015 - April 2017).
- Analysis of preoperative and intraoperative data to determine stroke associations.
- Neurological chart review to ascertain last known well time and stroke etiology.
Main Results:
- 1.5% (43/2795) of patients experienced perioperative stroke, with 72% being embolic.
- Stroke risk increased with age (OR 1.04), history of stroke (OR 2.73), and thoracic aorta disease (OR 3.36).
- 74% of strokes were identified after postoperative day one, with 81% having a preoperative last known well time.
Conclusions:
- Delayed stroke recognition, evidenced by preoperative last known well times in late-diagnosed strokes, contributes to the timing of perioperative strokes.
- Consider frequent neurological monitoring within 24 hours for all cardiac surgery patients, especially those at higher risk (elderly, history of stroke, thoracic aorta disease).
- Improved early recognition of perioperative stroke is crucial for better patient outcomes.
Introduction:
More than half of reported perioperative strokes following cardiac surgery are identified beyond postoperative day one. The objective of our study was to determine preoperative and intraoperative factors that are associated with stroke following cardiac surgery and to identify factors that may contribute delayed recognition of perioperative stroke.
Methods:
Patients undergoing coronary artery bypass surgery or isolated valve surgery from January 2, 2015 to April 28, 2017 at an academic health system were identified from the Society of Thoracic Surgeons Registry. We determined preoperative and intraoperative factors associated with perioperative stroke. Two neurologists performed retrospective chart reviews on perioperative stroke patients to determine the last seen well time and the stroke cause.
Results:
During the study period, 2795 patients underwent coronary artery bypass surgery or isolated valve surgery (mean age 64 ± 11 years, 71% male, 72% Caucasian, 9% history of stroke), of which 43 (1.5%) had a perioperative stroke; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, perioperative strokes were independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after postoperative day one in 32 (74%) patients of which 26 (81%) had a preoperative last seen well time.
Conclusion:
Given the high frequency of preoperative last seen well time in perioperative stroke patients who are identified after postoperative day one, delayed stroke recognition may contribute to the bimodal distribution in timing of perioperative stroke. Frequent neurological monitoring within 24 hours after CABG or isolated valve surgery should be considered for all patients undergoing cardiac surgery, particularly elderly patients and those with a history of stroke or thoracic aorta disease, to improve early stroke recognition.
More Related Videos
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Cardiac Catheterization IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:22Aneurysm IV: Nursing Management
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management