33. Stroke in Cardiac Surgical Patients: Determinants and Outcome
G. Hossein Almassi, Tracy Sommers, Thomas E. Moritz, A. Laurie Shroyer, Martin J. London, William G. Henderson, Gulshan K. Sethi, Frederick L. Grover, Karl E. Hammermeister
Medical College of Wisconsin
Milwaukee, Wis.
VA Medical Centers
Milwaukee, Wis., Denver, Colo., Tucson, Ariz.
Background: Stroke remains a major source of morbidity, mortality and prolonged hospitalization in cardiac surgical patients. Few large scale studies are available on this morbid event. We determined the incidence and predictors of preoperative stroke and its impact on patientsÂ’ outcome.
Methods: Data on 4,936 patients undergoing cardiac operations were analyzed at 14 participating VA hospitals in the "VA Cooperative Study: Processes, Structures, and Outcomes of Care in Cardiac Surgery" between September 1992 and December 1996. Variables were prospectively collected and analyzed with univariate and multiple logistic regression analysis.
Results: Stroke incidence was 3.4 percent. Determinants of stroke were increasing age, prior stroke, hypertension, diuretics within two weeks of surgery, serum creatinine, surgical priority, lack of safety factors in the cardiopulmonary bypass machine, atrial fibrillation, and total ischemic time. Patients with stroke had higher in-hospital mortality (22 percent versus 3.6 percent), mortality at six months, (29 percent versus 5.3 percent), longer median ICIU stay (6.8 days versus 2.7 days) and longer hospitalization (31 days versus eight days); p <0.001 for all comparisons.
Conclusions: Stroke following cardiac operations increases in-hospital and six month mortality, and hospitalization. Stroke is predicted by multiple risk factors. Identification and modification of these risk factors may prevent stroke.