Key result
The incidence of postoperative stroke after cardiopulmonary bypass was not significantly higher in octogenarians compared to matched younger patients (4.1% vs 3.5%; P=0.65).
Why the study?
Does cardiac surgery with cardiopulmonary bypass increase the risk of postoperative stroke in octogenarians compared to younger matched patients?
Cohort (n=844)
Does cardiac surgery with cardiopulmonary bypass increase the risk of postoperative stroke in octogenarians compared to younger matched patients?
Absolute Event Rate: 4.1% vs 3.5%
p-value: p=0.65
Octogenarians undergoing cardiac surgery with cardiopulmonary bypass do not have a significantly higher incidence of postoperative stroke compared to matched younger patients, though preoperative anaemia is a critical risk factor in this elderly population.
Comparable stroke rates after CPB in octogenarians versus younger patients; leaves open anaemia's role as a modifiable factor in larger cohorts.
OBJECTIVES: Demographics of cardiac surgery patients are changing, with an increase in aged patients. We aim to identify risk factors, mortality, morbidity and increasing postoperative costs due to postoperative stroke in octogenarians following cardiopulmonary bypass (CPB). METHODS: A total of 418 consecutive patients older than 80 years (Group A) who underwent cardiac surgery with CPB between 2000 and 2012 were matched according to gender, surgical procedure and comorbidities with 426 younger patients (Group B). Risk factors for postoperative stroke were retrospectively evaluated. RESULTS: We identified postoperative stroke in 4.1% of patients in Group A and in 3.5% in Group B (P = 0.65). Early stroke was diagnosed in 13 patients in Group A (76.5%) and 10 patients in Group B (66.7%) (P = 0.53). In multivariate analysis, preoperative anaemia (P = 0.033; odds ratio [OR]: 3.84; 95% CI: 1.11-13.28) was the only risk factor associated with postoperative stroke in Group A. In Group B, preoperative peripheral vascular disease (P = 0.0003; OR: 7.30; 95% CI: 2.47-21.55) and postoperative atrial fibrillation (P = 0.0134; OR: 4.05; 95% CI: 1.33-12.31) were identified as risk factors. CONCLUSIONS: Incidence of postoperative stroke after CPB was not significantly higher in our octogenarian population. Although in younger patients peripheral vascular disease and cardiac rhythm disturbances were significant risk factors, it seems that factors related to intraoperative brain oxygenation (secondary to preoperative anaemia) are the most critical determinant of stroke in the elderly.
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Carrascal et al. (2014) conducted a cohort in Cardiac surgery with cardiopulmonary bypass (n=844). Age >80 years (octogenarians) vs. Younger patients was evaluated on Postoperative stroke (p=0.65). The incidence of postoperative stroke after cardiopulmonary bypass was not significantly higher in octogenarians compared to matched younger patients (4.1% vs 3.5%; P=0.65).
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