Analysis of Acute Cerebrovascular Accidents following Cardiovascular Surgical Procedures: A Comprehensive 17-year Study Involving 24,412 Patients at a Leading Tertiary Care Institution in the United Kingdom

Abstract

BACKGROUND: The primary objective of this study is to quantify the incidence of stroke following cardiac surgery over 17 years at our center. Additionally, we evaluated the potential risk factors leading to postoperative stroke in these patients. METHODS: Patient characteristics and perioperative data were collected for 24,412 patients undergoing surgery at our center between January 2005 and December 2021. We identified the patients who developed postoperative stroke and assessed potential risk factors. Chi-squared and Mann-Whitney U-tests were used for intergroup comparisons. Independent risk factors were evaluated by univariate logistic regression analysis. RESULTS: In our cohort, we identified 346 patients (1.4%) with postoperative stroke. After adjusting for possible confounders, the following were significant risk factors: previous cardiac surgery (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2-2.2; P = 0.004), EuroSCORE II of 1-1.9 (OR: 2.1; CI :1-4.2; P = 0.048), 2-4.9 (OR: 3.3; CI: 1.7-6.6; P = 0.001), 5-9.9 (OR: 3.6; CI: 1.7-7.5; P = 0.001), and =10 (OR: 3.4; CI: 1.6-7.5; P = 0.002), EuroSCORE additive of 5-9 (OR: 2.4; CI: 1.2-4.7; P = 0.013) and =10 (OR: 2.7; CI: 1.2-6.2; P = 0.020), requiring new postoperative hemofiltration/dialysis (OR: 4.0; CI: 2.9-5.5, P < 0.001), Stanford type A dissections (OR: 2.3; CI: 1.1-4.7; P = 0.020), returning to theater for bleeding/tamponade (OR: 3.2; CI: 2.2-4.6; P < 0.001). CONCLUSION: The incidence of stroke following surgery is low with many predisposing factors. Nevertheless, identifying patients at increased risk of stroke may enhance informed consent, preoperative planning, and perioperative strategies.