The incidence of early neurological complications after on-pump cardiac surgery: a retrospective study

IF 0.1 Q4 ANESTHESIOLOGY
J. Houthuys, A. Schrijvers, D. Van Beersel, W. Botermans, L. Al Tmimi
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引用次数: 0

Abstract

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a significant risk for neurological complications. Reported incidence and risk factors for these complications vary significantly. Identifying risk factors could lead to preventive strategies to reduce complications and improve patient’s outcome. Objective: The study aims to assess the overall incidence and risk factors for severe early postoperative neurological complications after elective on-pump cardiac surgery. We specifically analyzed the incidence of stroke, global cerebral ischemia (GCI) and epilepsy in these patients. Methods: After getting approval from the Ethics Committee Research UZ/KU Leuven, on 14/12/2021 (s65871), we retrospectively evaluated data of 1080 adult patients after cardiac surgery with CPB between 06/2019 and 06/2021 at the University Hospitals Leuven. After exclusion of emergency procedures and patients who died before neurological evaluation, 977 patients remained for primary analysis. All data were collected from the electronic patient’s file. Primary objective was to identify the incidence of stroke, GCI and epilepsy. We defined stroke and GCI according to the American Stroke Association. Secondary endpoints were identifying independent risk-factors and assessing the impact of early neurological complications on mortality. Statistical analysis was performed using econometric and statistical modeling with python. We performed univariate logistic regression with Bonferonni correction and multivariable logistic regression with backwards elimination approach and p-value set to be <0.05. Results: The overall incidence of defined neurological complications after elective on-pump cardiac surgery at our institution was 3.17% (n=31) (stroke 2.35% (n=23), epilepsy 0.61% (n=6) and GCI 0.31% (n=3)). No statistically significant risk factors for these complications were found. In secondary analysis, patients with stroke and GCI had a higher risk of in-hospital mortality (Fisher’s exact test resulted in odds ratio 7.23 with p=0.005 and odds ratio 65.17 with p=0.003 respectively) Diabetes mellitus, preoperative atrial fibrillation, and endocarditis were also significantly related to in-hospital mortality. Conclusions: The incidence of early neurological complications after elective on-pump cardiac surgery at our institution was comparable to that reported in earlier studies. No independent risk factors for these neurological complications were found. The occurrence of stroke and GCI significantly increased in-hospital mortality which emphasizes the importance of these complications, with possible mortality benefit of early recognition and management of stroke.
心脏直视手术后早期神经系统并发症的发生率:一项回顾性研究
背景:心肺转流(CPB)心脏手术与神经系统并发症的重大风险相关。报告的这些并发症的发生率和危险因素差异很大。识别风险因素可以制定预防策略,以减少并发症并改善患者的预后。目的:本研究旨在评估择期心脏直视手术后早期严重神经系统并发症的总体发生率和危险因素。我们专门分析了这些患者的中风、全脑缺血(GCI)和癫痫的发病率。方法:在获得伦理委员会研究UZ/KU Leuven于2021年12月14日(s65871)的批准后,我们回顾性评估了2019年6月至2021年6月在鲁汶大学医院进行CPB心脏手术后的1080名成年患者的数据。在排除紧急手术和神经系统评估前死亡的患者后,977名患者仍在进行初步分析。所有数据都是从电子病人档案中收集的。主要目的是确定中风、GCI和癫痫的发病率。我们根据美国中风协会定义了中风和GCI。次要终点是确定独立的风险因素并评估早期神经系统并发症对死亡率的影响。统计分析采用计量经济学和python统计建模进行。我们进行了Bonferonni校正的单变量逻辑回归和向后消除法的多变量逻辑回归,p值设置为<0.05。结果:在我们机构进行选择性心脏泵送手术后,明确的神经系统并发症的总发生率为3.17%(n=31)(中风2.35%(n=23),癫痫0.61%(n=6)和GCI 0.31%(n=3))。没有发现这些并发症具有统计学意义的危险因素。在二次分析中,中风和GCI患者的住院死亡率风险较高(Fisher精确检验的比值比分别为7.23和65.17,分别为0.005和0.003)糖尿病、术前心房颤动和心内膜炎也与住院死亡率显著相关。结论:在我们机构进行选择性心脏泵送手术后,早期神经系统并发症的发生率与早期研究报告的发生率相当。没有发现这些神经系统并发症的独立危险因素。中风和GCI的发生显著增加了住院死亡率,这强调了这些并发症的重要性,早期识别和管理中风可能对死亡率有益。
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来源期刊
CiteScore
0.20
自引率
0.00%
发文量
2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
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