JTCVS open · 2025
Outcomes after cardiac surgery in patients with epilepsy: A nationwide analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Cabulong Alexander P, Zhou Guangjin, Maigrot Jean-Luc A, Soltesz Edward G, Schiltz Nicholas, Koroukian Siran M
Аннотация
OBJECTIVE: To assess outcomes after cardiac surgery in patients with epilepsy.
METHODS: We queried the 2016-2019 Nationwide Readmissions Database for adult patients undergoing coronary artery bypass grafting, valve and aortic surgeries, or combination procedures. We compared mortality at index admission, complications, and 90-day readmissions between groups of patients with and without epilepsy before and after propensity-score matching. We used logistic regression analysis to evaluate the risk of adverse postoperative outcomes in the epilepsy group compared with their counterparts without epilepsy.
RESULTS: There were 1,104,303 patients identified who underwent cardiac surgery; of those, 15,492 (1.4%) had epilepsy. Patients with epilepsy more often had additional comorbidities, including congestive heart failure, chronic lung disease, and renal failure. Even after propensity-score matching, mortality at index admission (5.2% vs 3.6%), overall complications (44.2% vs 31.4%), and 90-day readmissions (27.3% vs 21.3%) were greater among patients with epilepsy than those without (P < .001 for all comparisons). Patients with epilepsy more frequently experienced specific complications, including stroke, pneumonia and respiratory complications, and infection/sepsis during index admissions. In the adjusted matched analysis, epilepsy was associated with a greater risk of mortality at index admission (adjusted odds ratio [aOR], 1.34; 95% confidence interval, 1.20-1.50), overall complications (aOR, 1.35; 1.28-1.42), and 90-day readmission (aOR, 1.37; 1.29-1.45).
CONCLUSIONS: Further studies are necessary to identify strategies to improve outcomes after cardiac surgery in patients with epilepsy, as they have greater associated risks of postoperative mortality, complications, and readmission.
METHODS: We queried the 2016-2019 Nationwide Readmissions Database for adult patients undergoing coronary artery bypass grafting, valve and aortic surgeries, or combination procedures. We compared mortality at index admission, complications, and 90-day readmissions between groups of patients with and without epilepsy before and after propensity-score matching. We used logistic regression analysis to evaluate the risk of adverse postoperative outcomes in the epilepsy group compared with their counterparts without epilepsy.
RESULTS: There were 1,104,303 patients identified who underwent cardiac surgery; of those, 15,492 (1.4%) had epilepsy. Patients with epilepsy more often had additional comorbidities, including congestive heart failure, chronic lung disease, and renal failure. Even after propensity-score matching, mortality at index admission (5.2% vs 3.6%), overall complications (44.2% vs 31.4%), and 90-day readmissions (27.3% vs 21.3%) were greater among patients with epilepsy than those without (P < .001 for all comparisons). Patients with epilepsy more frequently experienced specific complications, including stroke, pneumonia and respiratory complications, and infection/sepsis during index admissions. In the adjusted matched analysis, epilepsy was associated with a greater risk of mortality at index admission (adjusted odds ratio [aOR], 1.34; 95% confidence interval, 1.20-1.50), overall complications (aOR, 1.35; 1.28-1.42), and 90-day readmission (aOR, 1.37; 1.29-1.45).
CONCLUSIONS: Further studies are necessary to identify strategies to improve outcomes after cardiac surgery in patients with epilepsy, as they have greater associated risks of postoperative mortality, complications, and readmission.