Cause-Specific Mortality as a Sequela of Perioperative Stroke Following Cardiac and Vascular Surgery

• Authors: Nathan J Reinert, University of Pittsburgh; Bansri M Patel, University of Pittsburgh; Qasem N Shaer, Emory University; Liwen Wu, University of Pittsburgh; Stephen Wisniewski, University of Pittsburgh; Eric S Hager, University of Pittsburgh; Mitchell R Dyer, University of Pittsburgh; Parthasarathy D Thirumala, University of Pittsburgh
• Journal Title: NEUROLOGIST
• Volume: Volume 27, Number 1
• Publisher: Lippincott, Williams & Wilkins | 2021-11-30, Pages 21-26
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/NRL.0000000000000384
• Subjects: Biology, Biostatistics; Health Sciences, Medicine and Surgery
• Keywords: Vascular Surgery; Perioperative Stroke

Abstract

Background: There is a paucity of data regarding cause-specific mortality following a perioperative stroke. In this study, we aim to establish the risk of cause-specific mortality associated with perioperative stroke following cardiac and vascular procedures at 30 days, 90 days, and 1-year postoperative. It is hoped that this fund of knowledge will enhance perioperative risk stratification and medical management for patients who have suffered a perioperative stroke. Methods: This is a retrospective cohort study evaluating 277,654 cardiac and vascular surgical patients dually documented within the Inpatient Discharge Claims Database and the Pennsylvania Department of Health Death Statistics database. A univariate assessment followed by a multivariate logistic regression analysis was used to determine the odds of cerebrovascular, cardiovascular, pulmonary, malignancy, infectious, and dementia causes of mortality following perioperative stroke. Results: Perioperative stroke significantly increased the odds of overall mortality (p<.0001) as well as cause-specific mortality in all categories (p<0.05) except dementia (p=0.8907) at all time end points. Cerebrovascular-related mortality was most impacted by perioperative stroke (aOR 34.5 [29.1, 40.9], p<0.0001 at 30 days). Conclusions: Perioperative stroke in the cardiac and vascular surgical population is associated with increased odds of overall, cerebrovascular, cardiovascular, pulmonary, malignancy, and infectious causes of mortality at 30 days, 90 days, and 1-year postoperatively when compared to patients who did not experience a perioperative stroke.