Neurological complications after cardiac surgery: A retrospective case-control study of risk factors and outcome

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Abstract

Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results: A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.

Original languageEnglish
Article number23
JournalJournal of Cardiothoracic Surgery
Volume14
Issue number1
DOIs
Publication statusSubmitted - Sep 21 2018

Fingerprint

Thoracic Surgery
Case-Control Studies
Stroke
Length of Stay
Carotid Stenosis
Control Groups
Delirium
Transient Ischemic Attack
Hospital Mortality
Ambulatory Surgical Procedures
Psychotic Disorders
Intensive Care Units
Atherosclerosis
Seizures
Hospitalization
Multivariate Analysis
Tomography
Magnetic Resonance Imaging
Mortality
Incidence

Keywords

  • Atherosclerosis
  • Cardiac surgery
  • Carotid arteries
  • CT-scan
  • MRI
  • Neurocognitive deficits

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{b61667cdac824430a2e57876f258d168,
title = "Neurological complications after cardiac surgery: A retrospective case-control study of risk factors and outcome",
abstract = "Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3{\%}) underwent brain computed tomography (70/91, 77{\%}) or magnetic resonance imaging (21/91, 23{\%}) scan because of major stroke (37/2121, 1.7{\%}) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5{\%}). The mean age was 65.3 ± 12.1 years and 60 (65.9{\%}) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results: A total of 37/2121 (1.7{\%}) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19{\%}], and 12/54 patients [22{\%}] vs. 4/115 patients [3{\%}], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.",
keywords = "Atherosclerosis, Cardiac surgery, Carotid arteries, CT-scan, MRI, Neurocognitive deficits",
author = "Raffa, {Giuseppe Maria} and Francesco Agnello and Giovanna Occhipinti and Roberto Miraglia and {Lo Re}, Vincenzina and Gianluca Marrone and Fabio Tuzzolino and Antonio Arcadipane and Michele Pilato and Angelo Luca",
year = "2018",
month = "9",
day = "21",
doi = "10.1186/s13019-019-0844-8",
language = "English",
volume = "14",
journal = "Journal of Cardiothoracic Surgery",
issn = "1749-8090",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Neurological complications after cardiac surgery

T2 - A retrospective case-control study of risk factors and outcome

AU - Raffa, Giuseppe Maria

AU - Agnello, Francesco

AU - Occhipinti, Giovanna

AU - Miraglia, Roberto

AU - Lo Re, Vincenzina

AU - Marrone, Gianluca

AU - Tuzzolino, Fabio

AU - Arcadipane, Antonio

AU - Pilato, Michele

AU - Luca, Angelo

PY - 2018/9/21

Y1 - 2018/9/21

N2 - Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results: A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.

AB - Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits. Results: A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications. Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications.

KW - Atherosclerosis

KW - Cardiac surgery

KW - Carotid arteries

KW - CT-scan

KW - MRI

KW - Neurocognitive deficits

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U2 - 10.1186/s13019-019-0844-8

DO - 10.1186/s13019-019-0844-8

M3 - Article

C2 - 30683130

AN - SCOPUS:85060535731

VL - 14

JO - Journal of Cardiothoracic Surgery

JF - Journal of Cardiothoracic Surgery

SN - 1749-8090

IS - 1

M1 - 23

ER -