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Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis
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  • Jayenthan Karunanantham,
  • Jason Ali,
  • Nicholas Evans,
  • Stephen Webb,
  • Stephen R. Large
Jayenthan Karunanantham
Royal Papworth Hospital
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Jason Ali
Royal Papworth Hospital
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Nicholas Evans
University of Cambridge
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Stephen Webb
Royal Papworth Hospital
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Stephen R. Large
Royal Papworth Hosp
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Abstract

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 perioperative stroke.

Peer review status:Published

27 Jun 2020Submitted to Journal of Cardiac Surgery
27 Jun 2020Submission Checks Completed
27 Jun 2020Assigned to Editor
02 Jul 2020Reviewer(s) Assigned
10 Jul 2020Review(s) Completed, Editorial Evaluation Pending
13 Jul 2020Editorial Decision: Revise Major
14 Jul 20201st Revision Received
16 Jul 2020Submission Checks Completed
16 Jul 2020Assigned to Editor
16 Jul 2020Reviewer(s) Assigned
07 Aug 2020Review(s) Completed, Editorial Evaluation Pending
08 Aug 2020Editorial Decision: Accept
16 Aug 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.14964