Risk Score Elaboration for Stroke in Cardiac Surgery

Abstract

Introduction Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity. The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass. Methods A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model’s performance was then validated using data from the remainder of the patients (n=1,604). The model’s accuracy was tested using the area under the receiver operating characteristic (ROC) curve. Results The prevalence of stroke during the postoperative period was 3% (n=149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥ 110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66 - 0.75). Conclusion We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.

Acquisition of the New Affinity 30 Vascular Color Doppler Ultrasound Device - Cost Benefit Analysis with the Aim of Reducing the Costs of Cardiosurgical Patients’ Treatment

“…However, it is still one of the most serious complications for cardiac surgery patients. CVI is associated with 21 to 23% intra-hospital mortality ( 7 , 8 ), and up to 43% ( 3 ). Combined AS and carotid artery disease is currently present in approximately 8% of patients undergoing cardiac surgery (range 2-22% depending on the definition of stenosis, diagnostic method, and frequency of screening) ( 2 ).…”

“…Cerebrovascular Cerebrovascular accidents (CVI) are considered the second most serious complication in cardiac surgery patients with a frequency of 10% ( 1 - 3 ). They are often fatal and leave permanent disability.…”

“…The effects of preoperative CDU examination in cardiac surgery patients, who have a significantly higher prevalence/incidence of atherosclerosis, are considerably greater than in the general population due to additional comorbidity, and according to the current SCORE scales for the operative risk of CVI, they range over 11.8%, depending on comorbidity ( 3 ). Current cost-effectiveness studies in patients with AS disease CA predict significantly higher savings after Color Doppler Ultrasound (CDU) evaluation and selection of optimal therapy.…”