Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Turner C. Lisle, Kevin M Barrett, Leo M. Gazoni, Brian R. Swenson, Christopher D. Scott, Ali Kazemi, John A. Kern, Benjamin B. Peeler, Irving L. Kron, Karen C. Johnston

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge. Methods: We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (≤ 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors. Results: The stroke incidence was 2.8%. Postoperative strokes occurred within 24 hours in 22.8% (46 of 202) and after 24 hours in 77.2% (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001). Conclusions: Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.

Original languageEnglish (US)
Pages (from-to)1556-1563
Number of pages8
JournalAnnals of Thoracic Surgery
Volume85
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

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Cardiopulmonary Bypass
Stroke
Mortality
Rehabilitation
Odds Ratio
National Institutes of Health (U.S.)
Logistic Models
Regression Analysis
Chronic Renal Insufficiency
Nervous System
Survivors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Lisle, T. C., Barrett, K. M., Gazoni, L. M., Swenson, B. R., Scott, C. D., Kazemi, A., ... Johnston, K. C. (2008). Timing of Stroke After Cardiopulmonary Bypass Determines Mortality. Annals of Thoracic Surgery, 85(5), 1556-1563. https://doi.org/10.1016/j.athoracsur.2008.02.035

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality. / Lisle, Turner C.; Barrett, Kevin M; Gazoni, Leo M.; Swenson, Brian R.; Scott, Christopher D.; Kazemi, Ali; Kern, John A.; Peeler, Benjamin B.; Kron, Irving L.; Johnston, Karen C.

In: Annals of Thoracic Surgery, Vol. 85, No. 5, 05.2008, p. 1556-1563.

Research output: Contribution to journalArticle

Lisle, TC, Barrett, KM, Gazoni, LM, Swenson, BR, Scott, CD, Kazemi, A, Kern, JA, Peeler, BB, Kron, IL & Johnston, KC 2008, 'Timing of Stroke After Cardiopulmonary Bypass Determines Mortality', Annals of Thoracic Surgery, vol. 85, no. 5, pp. 1556-1563. https://doi.org/10.1016/j.athoracsur.2008.02.035
Lisle, Turner C. ; Barrett, Kevin M ; Gazoni, Leo M. ; Swenson, Brian R. ; Scott, Christopher D. ; Kazemi, Ali ; Kern, John A. ; Peeler, Benjamin B. ; Kron, Irving L. ; Johnston, Karen C. / Timing of Stroke After Cardiopulmonary Bypass Determines Mortality. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 5. pp. 1556-1563.
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abstract = "Background: Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge. Methods: We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (≤ 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors. Results: The stroke incidence was 2.8{\%}. Postoperative strokes occurred within 24 hours in 22.8{\%} (46 of 202) and after 24 hours in 77.2{\%} (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001). Conclusions: Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.",
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AU - Scott, Christopher D.

AU - Kazemi, Ali

AU - Kern, John A.

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N2 - Background: Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge. Methods: We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (≤ 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors. Results: The stroke incidence was 2.8%. Postoperative strokes occurred within 24 hours in 22.8% (46 of 202) and after 24 hours in 77.2% (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001). Conclusions: Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.

AB - Background: Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge. Methods: We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (≤ 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors. Results: The stroke incidence was 2.8%. Postoperative strokes occurred within 24 hours in 22.8% (46 of 202) and after 24 hours in 77.2% (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001). Conclusions: Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.

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