title: Preoperative stroke and outcomes after coronary artery bypass graft surgery.
abstract: BACKGROUND
  Data are lacking on the optimal scheduling of coronary artery bypass grafting (CABG) surgery after stroke. The authors investigated the preoperative predictors of adverse outcomes in patients undergoing CABG, with a focus on the importance of the time interval between prior stroke and CABG.
  
  
  METHODS
  The Hospital Episode Statistics database (April 2006-March 2010) was analyzed for elective admissions for CABG. Independent preoperative patient factors influencing length of stay, postoperative stroke, and mortality, were identified by logistic regression and presented as adjusted odds ratios (OR).
  
  
  RESULTS
  In all, 62,104 patients underwent CABG (1.8% mortality). Prior stroke influenced mortality (OR 2.20 [95% CI 1.47-3.29]), postoperative stroke (OR 1.99 [1.39-2.85]), and prolonged length of stay (OR 1.31 [1.11-1.56]). The time interval between stroke and CABG did not influence mortality or prolonged length of stay. However, a longer time interval between stroke and CABG surgery was associated with a small increase in risk of postoperative stroke (OR per month elapsed 1.02 [1.00-1.04]; P = 0.047). An interaction was evident between prior stroke and myocardial infarction for death (OR 5.50 [2.84-10.8], indicating the importance of the combination of comorbidities. Prominent effects on mortality were also exerted by liver disease (OR 20.8 [15.18-28.51]) and renal failure (OR 4.59 [3.85-5.46]).
  
  
  CONCLUSIONS
  The authors found no evidence that more recent preoperative stroke predisposed patients undergoing CABG surgery to suffer postoperative stroke, death, or prolonged length of stay. The combination of prior stroke and myocardial infarction substantially increased perioperative risk.
authors.affiliation: School of Public Health, Imperial College London, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Abdul
authors.initials: A
authors.lastname: Mozid
authors.forename: Hilary P
authors.initials: HP
authors.lastname: Grocott
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Walters
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sanders
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome