Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome

Giuseppe Maria Raffa,Michele Pilato,Giovanna Occhipinti,Antonio Arcadipane,Vincenzina Lo Re,Angelo Luca,Francesco Agnello,Roberto Miraglia,Gianluca Marrone,Fabio Tuzzolino

doi:10.1186/s13019-019-0844-8

Abstract

BackgroundTo evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery.MethodsA 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.ResultsA 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.ConclusionsNeurological 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.

Highlights

To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery
Few studies have evaluated the incidence of postoperative neurological complications in a large group of patients who have undergone a variety of cardiac procedures [10, 12, 14]
The control group was composed of 113 cardiac surgery patients without neurological complications selected according to age, gender, and type of intervention

Summary

Introduction

Risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. Postoperative neurological impairment after cardiac surgery is a serious complication [1,2,3]. Several studies have evaluated postoperative neurologic complications and risk factors in cardiac surgery patients, though the results are conflicting, or incomplete mainly due to a low number of interventions or a low number of variables. Some studies have reported the association between prolonged cardiopulmonary bypass and the development of postoperative stroke [11, 14], while others have questioned its significance [11, 13]. Few studies have evaluated the incidence of postoperative neurological complications in a large group of patients who have undergone a variety of cardiac procedures [10, 12, 14]

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