Ching-Chang Chen1, Tien-Hsing Chen2, Po-Hsun Tu1, Victor Chien-Chia Wu2, Chia-Hung Yang2, Alvin Yi-Chou Wang1, Shih-Tseng Lee1, Feng-Chun Tsai3, Shao-Wei Chen4. 1. Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. 2. Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. 3. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. 4. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan. Electronic address: josephchen0314@gmail.com.
Abstract
BACKGROUND: Postoperative stroke is one of the most devastating complications of cardiac surgery. When life-threatening situations such as large infarction and hemorrhage occur, neurosurgical procedures may be performed. In this study, we analyzed the long-term medical and surgical outcomes of stroke after cardiac surgery. METHODS: We conducted a retrospective, nationwide, population-based study. All enrolled patients underwent first-time cardiac surgery and were further divided into the subgroups of nonstroke, stroke with medical treatment, and stroke with neurosurgical treatment. All-cause mortality, recurrent stroke, and readmission were analyzed. RESULTS: We included 67,051 patients in this study. Patients with postoperative stroke (2.6%, n = 1,731) exhibited an in-hospital mortality rate of 12.3% (n = 213) and a 5-year mortality rate of 49.1% (n = 850). Unprecedentedly, the 83 patients who underwent neurosurgical procedures exhibited an in-hospital mortality of 16.9%; this rate increased to 65.1% at the 5-year follow-up. This neurosurgical subgroup exhibited the highest rate of long-term mortality (p < 0.001). In the neurosurgical subgroup, age was the risk factor for all-cause mortality (hazard ratio, 2.60; 95% confidence interval, 1.60-4.24; p < 0.001). CONCLUSIONS: Postoperative stroke often leads to high mortality and poor long-term outcomes. Patients who experienced a severe stroke and underwent neurosurgical procedures also exhibited poor outcomes. Patients and their families should be informed of relatively high mortality and poor long-term outcomes before neurosurgical operation.
BACKGROUND:Postoperative stroke is one of the most devastating complications of cardiac surgery. When life-threatening situations such as large infarction and hemorrhage occur, neurosurgical procedures may be performed. In this study, we analyzed the long-term medical and surgical outcomes of stroke after cardiac surgery. METHODS: We conducted a retrospective, nationwide, population-based study. All enrolled patients underwent first-time cardiac surgery and were further divided into the subgroups of nonstroke, stroke with medical treatment, and stroke with neurosurgical treatment. All-cause mortality, recurrent stroke, and readmission were analyzed. RESULTS: We included 67,051 patients in this study. Patients with postoperative stroke (2.6%, n = 1,731) exhibited an in-hospital mortality rate of 12.3% (n = 213) and a 5-year mortality rate of 49.1% (n = 850). Unprecedentedly, the 83 patients who underwent neurosurgical procedures exhibited an in-hospital mortality of 16.9%; this rate increased to 65.1% at the 5-year follow-up. This neurosurgical subgroup exhibited the highest rate of long-term mortality (p < 0.001). In the neurosurgical subgroup, age was the risk factor for all-cause mortality (hazard ratio, 2.60; 95% confidence interval, 1.60-4.24; p < 0.001). CONCLUSIONS:Postoperative stroke often leads to high mortality and poor long-term outcomes. Patients who experienced a severe stroke and underwent neurosurgical procedures also exhibited poor outcomes. Patients and their families should be informed of relatively high mortality and poor long-term outcomes before neurosurgical operation.