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- Title
Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome.
- Authors
Raffa, Giuseppe Maria; Agnello, Francesco; Occhipinti, Giovanna; Miraglia, Roberto; Lo Re, Vincenzina; Marrone, Gianluca; Tuzzolino, Fabio; Arcadipane, Antonio; Pilato, Michele; Luca, Angelo
- Abstract
<bold>Background: </bold>To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
COMPLICATIONS of cardiac surgery; TRANSIENT ischemic attack; INTERNAL carotid artery; DISEASE risk factors; CASE-control method
- Publication
Journal of Cardiothoracic Surgery, 2019, Vol 14, Issue 1, p1
- ISSN
1749-8090
- Publication type
journal article
- DOI
10.1186/s13019-019-0844-8