Preoperative stroke before cardiac surgery does not increase risk of postoperative stroke

Caleb R Matthews,Lawrence S Lee,Cameron L Colgate,Niharika Namburi,Timothy Hartman,Zainab Faiza,Nicolas W Villelli,Mackenzie Madison

doi:10.1038/s41598-021-88441-y

Abstract

The optimal time when surgery can be safely performed after stroke is unknown. The purpose of this study was to investigate how cardiac surgery timing after stroke impacts postoperative outcomes between 2011–2017 were reviewed. Variables were extracted from the institutional Society of Thoracic Surgeons database, statewide patient registry, and medical records. Subjects were classified based upon presence of endocarditis and further grouped by timing of preoperative stroke relative to cardiac surgery: Recent (stroke within two weeks before surgery), Intermediate (between two and six weeks before), and Remote (greater than six weeks before). Postoperative outcomes were compared amongst groups. 157 patients were included: 54 in endocarditis and 103 in non-endocarditis, with 47 in Recent, 26 in Intermediate, and 84 in Remote. 30-day mortality and postoperative stroke rate were similar across the three subgroups for both endocarditis and non-endocarditis. Of patients with postoperative stroke, mortality was 30% (95% CI 4.6–66). Timing of cardiac surgery after stroke occurrence does not seem to affect postoperative stroke or mortality. If postoperative stroke does occur, subsequent stroke-related mortality is high.

Highlights

The optimal time when surgery can be safely performed after stroke is unknown
Stroke in the perioperative period represents a major source of the stroke burden in the United States, with up to $4 billion in additional healthcare costs annually being attributed to cardiac surgery patients a lone[1,2]
There remains a paucity of data on whether the etiology of stroke plays a role; for example, stroke in patients with infective endocarditis (IE) is likely due to septic embolization, which may inherently be different than stroke in patients with atherosclerotic vascular and coronary artery disease

Summary

Introduction

The optimal time when surgery can be safely performed after stroke is unknown. The purpose of this study was to investigate how cardiac surgery timing after stroke impacts postoperative outcomes between 2011–2017 were reviewed. Subjects were classified based upon presence of endocarditis and further grouped by timing of preoperative stroke relative to cardiac surgery: Recent (stroke within two weeks before surgery), Intermediate (between two and six weeks before), and Remote (greater than six weeks before). Timing of non-cardiac surgery has been well studied, and some have demonstrated elevated risk of postoperative stroke for up to nine months following neurological insult[7,8]. There is scant data regarding stroke and cardiac surgery, and the optimal timing when cardiac surgery can be safely performed after stroke is largely unknown. We sought to define optimal timing from stroke to intervention and to characterize how preoperative stroke impacts postoperative outcomes including stroke. We hypothesized that the shorter the duration between preoperative stroke and cardiac surgery, the greater the risk of postoperative stroke and mortality

Objectives

Methods

Results

Discussion

Conclusion