Impact of stroke on outcomes following cardiac surgery: Propensity
Background Stroke remains a devastating complication of cardiac surgery.
The aim of this study was to characterise the incidence of stroke and
analyse the impact of stroke on patient outcomes and survival. Methods A
retrospective analysis was performed of patients with a CT-confirmed
stroke diagnosis between 01/01/2015 and 31/03/2019 at a single centre.
2:1 propensity matching was performed to identify a control population.
Results Over the period 165 patients suffered a stroke (1.99%), with an
incidence ranging 0.85% for CABG to 8.14% for aortic surgery. The mean
age was 70.3 years and 58.8% were male. 18% had experienced a previous
stroke or TIA. Compared to the comparison group, patients experiencing
post-operative stroke had a significantly prolonged period of ICU
admission (8.0 vs 1.1 days p<0.001) and hospital length of
stay (12.94 vs 8.0 days p<0.001). Patient survival was also
inferior. In-hospital mortality was almost 3 times as high (17.0% vs
5.9%; p<0.001). Longer-term survival was also inferior on
Kaplan-Meier estimation (p<0.001). The 1-year and 3-year
survival were 61.5% and 53.8% respectively compared to 89.4% and
86.1% for the comparison group. Conclusion Perioperative stroke is a
devastating complication following cardiac surgery. Perioperative stroke
is associated with significantly inferior outcomes in terms of both
morbidity and mortality. Notably a 28% reduction in 1-year survival.
The potential to reduce morbidity and mortality with the emergence of
mechanical thrombectomy, demonstrates the need for clear links between
cardiothoracic and stroke teams to support individuals affected by