Abstract 11585: Long-term Survival of Stroke and Acute Delirium Following Cardiac Surgery is Compromised: Validation of a Prediction Model for Neurological Outcomes
Introduction: Neurological complications following cardiac surgery have a high in-hospital mortality and morbidity associated with it. Unlike the USA, the UK does not have a scoring system to predict such complications. Furthermore, little long-term data exists for survival from stoke, transient ischaemic attacks (TIAs) and acute delirium following cardiac surgery. We therefore looked at the long-term effects of neurological complications as well as developed and validated a scoring system to predict post-operative stroke.
Methods: Retrospective analysis of data collected prospectively on our cardiac database between July 1999 and March 2015. A multivariate logistic regression model was used to create a prediction model and the model was then validated. Long-term survival was evaluated using the Kaplan-Meier method.
Results: In total, 13,655 consecutive patients underwent cardiac surgery using cardiopulmonary bypass. Permanent stroke occurred in 1.1% of patients, acute delirium in 2.2% and TIAs in 1.1%. The validation for the final logistic regression model for permanent stroke showed a c-index of 0.717. Permanent stroke (38% vs 3%), TIA (6% vs 3%) and acute delirium (8% vs 3%) patients were significantly more likely (p<0.05) to have a higher in-hospital mortality compared to non-neurological complication patients. These neurological complications were significantly more likely to have longer hospital stays and rehabilitation (p<0.05). The long-term survival (2, 5, 10 & 15 years) was significantly less (p<0.05, log-rank) in those who survived stroke, TIA and acute delirium at hospital discharge compared to those discharged who did not sustain these pathologies (Figure 1).
Conclusion: We have developed a risk score to predict these neurological outcomes which will help identify those patients at the highest risk so they can be thoroughly counselled and optimised pre-operatively and that our annual resource allocation can be planned.
Author Disclosures: P. Ariyaratnam: None. M. Loubani: None. A. Vijayan: None.
- © 2015 by American Heart Association, Inc.