title: Timing of stroke after cardiopulmonary bypass determines mortality.
abstract: BACKGROUND
  Stroke is an important complication of cardiopulmonary bypass (CPB). This study determined if the timing of stroke events after CPB predicted stroke-related mortality or rehabilitation needs at hospital discharge.
  
  
  METHODS
  We performed a retrospective review of 7201 consecutive cardiac surgical patients during a 10-year period and identified 202 strokes. Postoperative stroke after CPB was classified as early (< or = 24 hours) or late (> 24 hours). Data were collected on patient characteristics, intraoperative variables and outcomes, postoperative course, stroke severity, and discharge status, including death from stroke. Logistic regression analysis was used to assess the relationship between the timing of stroke and discharge status after adjusting for clinically relevant factors.
  
  
  RESULTS
  The stroke incidence was 2.8%. Postoperative strokes occurred within 24 hours in 22.8% (46 of 202) and after 24 hours in 77.2% (156 of 202). Factors found in logistic regression analysis to be independently associated with stroke-related death included stroke within 24 hours postoperatively (odds ratio [OR], 9.16; p < 0.0001), preoperative chronic renal insufficiency (OR, 4.46; p = 0.01), and National Institute of Health Stroke Scale (NIHSS) score (OR, 1.16 per NIHSS point increase; p < 0.0001). Among survivors, early stroke was associated with greater rehabilitation needs (p < 0.001).
  
  
  CONCLUSIONS
  Early stroke after CPB is independently associated with higher stroke-related death and is associated with increased need for skilled rehabilitation at discharge. Neuroprotective strategies aimed at reducing early postoperative stroke may positively impact death and neurologic disability after CPB.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. tl4b@virginia.edu
authors.forename: Turner C
authors.initials: TC
authors.lastname: Lisle
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Barrett
authors.forename: Leo M
authors.initials: LM
authors.lastname: Gazoni
authors.forename: Brian R
authors.initials: BR
authors.lastname: Swenson
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Scott
authors.forename: Ali
authors.initials: A
authors.lastname: Kazemi
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000601:surgery*; D002423:Cause of Death; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000534:rehabilitation; D011184:Postoperative Period; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D000071939:Stroke Rehabilitation