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Postoperative stroke assessment inconsistencies in cardiac surgery: Contributors to higher stroke-related mortality?

Blair Riepen1, Diana DeAndrade1, Thomas F Floyd2

  • 1Department of Anesthesiology& Pain Management, The University of Texas Southwestern, Dallas, TX, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|March 11, 2023
PubMed

Insights

Postoperative stroke management after cardiac surgery varies significantly across institutions. Implementing best practices could improve patient outcomes for in-hospital stroke.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Healthcare Management

Background:

  • In-hospital stroke mortality is higher than out-of-hospital stroke.
  • Cardiac surgery patients face elevated risks for in-hospital stroke and associated mortality.
  • Institutional practice variations impact diagnosis, management, and outcomes of postoperative stroke.

Purpose of the Study:

  • To investigate variability in postoperative stroke management practices for cardiac surgical patients.
  • To test the hypothesis that institutional practices for managing postoperative stroke differ.

Main Methods:

  • A 13-item survey was used to assess practice patterns.
  • The survey targeted 45 academic institutions.
  • Practices related to preoperative risk identification, intraoperative monitoring, and postoperative stroke detection were examined.

Main Results:

  • Less than half of institutions (44%) have formal preoperative stroke risk identification.
  • Epiaortic ultrasonography for aortic atheroma detection is used routinely in only 16% of institutions.
  • Use of validated stroke assessment tools is inconsistent, with 44% unsure and 20% not using them routinely.

Conclusions:

  • Management of postoperative stroke in cardiac surgery patients shows significant variability.
  • Adopting a standardized, best-practices approach may enhance outcomes for postoperative stroke after cardiac surgery.
Abstract

Keywords:
Strokecardiac surgerymanagementperioperativepostoperative

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