Outcomes Following Perioperative Stroke in Cardiac Surgery Patients: A Retrospective Cohort Study.

OBJECTIVES

To identify independent predictors of 30-day mortality, adverse discharge, and length of hospital stay following a perioperative stroke among cardiac surgical patients, and to measure trends in outcomes over time.

DESIGN

A retrospective cohort study.

SETTING

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2020.

PARTICIPANTS

Cardiac surgery patients with perioperative stroke (n = 906).

INTERVENTIONS: None. Observational analysis.

MEASUREMENTS AND MAIN

RESULTS

Patient demographics, comorbid conditions, timing of stroke, procedure characteristics, and type of anesthesia information were extracted. The least absolute shrinkage and selection operator technique were employed to identify variables associated with 30-day mortality (the primary outcome), adverse discharge (death or a nonhome facility), and length of hospital stay. Perioperative stroke occurred a median (interquartile range) of 4 days (2-8 days) after surgery, 15% (134/906) of patients died, and 52% (351/906) were discharged to a facility that was not home. Factors significantly associated with 30-day mortality included increasing age, postoperative complications, fewer days from operation to stroke, and increased operative time (C-statistic = 0.794). Significant temporal changes in mortality or adverse discharge outcomes were not identified over the 15-year study period.

CONCLUSION

Cardiac perioperative strokes are associated with high rates of nonhome discharge and mortality, and those occurring sooner after cardiac surgery were associated with higher mortality, in addition to other factors. Outcomes did not change significantly over the 15-year study period. Further research should focus on effective interventions to improve outcomes after stroke following cardiac surgery.