Permanent stroke incidence after cardiac surgery increased from 1.13% in 2014 to 1.43% in 2023, significantly associated with prior cerebrovascular disease and urgent operative status.
The incidence of permanent stroke after cardiac surgery has risen over the past decade in Australia and New Zealand, largely driven by increasing patient complexity and non-elective surgical status.
Absolute Event Rate: 0% vs 0%
Introduction: Permanent stroke after cardiac surgery remains a major source of morbidity and mortality. Large-scale, contemporary data describing long-term incidence, risk factors, and outcomes in Australia and New Zealand are limited. This study examined the incidence and evolving risk profiles over the past decade using a comprehensive registry. Methods: Adults undergoing cardiac surgery (2014-2023) in the Australian and New Zealand Society of Cardiothoracic Surgery (ANZSCTS) Adult Cardiac Surgical Database were analysed. This bi-national clinical registry prospectively captures preoperative, intraoperative, and outcome data from >95% of cardiac surgeries in Australian and New Zealand. Permanent stroke was defined as a new neurological deficit persisting >72 hours. Trends were tested with the Cochran-Armitage test; multivariable logistic regression identified independent predictors; calendar year was excluded as a covariate to allow mechanistic interpretation of changes in predictor prevalence over time. Results: Among 137,720 patients, permanent stroke occurred in 2,104 patients (1.53%). Incidence increased from 1.13% in 2014 to 1.43% in 2023 (+27% relative change, p-trend<0.001). Independent predictors were prior cerebrovascular disease (OR 2.01, 95% CI 1.80-2.25), urgent/emergent/salvage operative status (OR 2.01, 95% CI 1.82-2.05), complex procedures (combined CABG-valve or multi-valve operations; OR 1.36, 95% CI 1.31-1.42), hypertension (OR 1.23, 95% CI 1.10-1.37), male sex (OR 1.19, 95% CI 1.07-1.31), diabetes (OR 1.19, 95% CI 1.08-1.32), advancing age (OR 1.01 per year, 95% CI 1.01-1.02), and longer cardiopulmonary bypass time (OR 1.01 per 10 minutes, 95% CI 1.01-1.02). Smoking history and dialysis were not independently associated. The temporal increase attenuated after adjustment, consistetnt with case-mix shifts. Stroke was associated with worse outcomes: higher 30-day mortality (19.1% vs 1.4%,), lower liklihood of discharge home (22.9% vs 78.6%), and greater rehabilitation requirement (40.6% vs 9.6%). Conclusions: Permanent stroke incidence after cardiac surgery in Australia and New Zealand has risen over the last decade, largely explained by evolving patient complexity. Patiets with prior cerebrovascular disease and non-elective status are at highest risk. Findings support risk-stratified neuroprotection and perioperative strategies to minimise modifiable contributors in high-risk patients.
Fanning et al. (Thu,) reported a other. Permanent stroke incidence after cardiac surgery increased from 1.13% in 2014 to 1.43% in 2023, significantly associated with prior cerebrovascular disease and urgent operative status.