Perioperative strokes after coronary artery bypass grafting with staged carotid endarterectomy: A nationwide perspective

Abstract

Study objective: To examine the risk of perioperative stroke on in-hospital morbidity and mortality in staged coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures.

Design: The National Inpatient Sample (NIS) database was used to extract data on all patients who underwent staged CABG CEA procedures. They were identified using the ICD-9 (International Classification of Diseases, Ninth Revision-Clinical Modification) diagnosis and procedure codes.

Setting: Multi-institutional.

Patients: Patients who underwent staged CABG and CEA from 1999 to 2011.

Interventions: Staged CABG and CEA procedures.

Measurements: Various pre-operative, and perioperative risk factors and their association with in-hospital mortality and morbidity were studied.

Main results: The study cohort was grouped into 2761 patients who underwent staged CEA and CABG. The average age of the patient population was 69years. An in-hospital mortality of 4.96% (137) was observed. Staged procedures showed a morbidity rate of 69.21%. Patients with perioperative strokes had a mortality rate of 16.73% following staged procedures. Other notable risk factors for mortality and morbidity were post-operative myocardial infarction (MI) and congestive heart failure (CHF).

Conclusion: Analysis of 2761 patients over a period of 12years (1999-2011) indicate perioperative stroke to be a strong post-operative predicator of in-hospital mortality and morbidity for staged procedures. Other significant factors such as advancing age, female gender and comorbidities like CHF, left ventricular dysfunction (LVD) and post-operative MI should also be considered when determining patient risk. Further investigative studies on staged CABG and CEA procedures are needed for better patient selection and for implementing preventative strategies such as neuroprotective medication and neuromonitoring to minimize the risk of ischemic strokes.

Keywords: Carotid endarterectomy; Coronary artery bypass grafting; In-hospital mortality; Morbidity; Perioperative strokes.