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Introduction: More than half of reported perioperative strokes following cardiac surgery are identified beyond postoperative day one. The objective of our study was to determine preoperative and intraoperative factors that are associated with stroke following cardiac surgery and to identify factors that may contribute delayed recognition of perioperative stroke. Methods: Patients undergoing coronary artery bypass surgery or isolated valve surgery from January 2, 2015 to April 28, 2017 at an academic health system were identified from the Society of Thoracic Surgeons Registry. We determined preoperative and intraoperative factors associated with perioperative stroke. Two neurologists performed retrospective chart reviews on perioperative stroke patients to determine the last seen well time and the stroke cause. Results: During the study period, 2795 patients underwent coronary artery bypass surgery or isolated valve surgery (mean age 64 ± 11 years, 71% male, 72% Caucasian, 9% history of stroke), of which 43 (1.5%) had a perioperative stroke; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, perioperative strokes were independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after postoperative day one in 32 (74%) patients of which 26 (81%) had a preoperative last seen well time. Conclusion: Given the high frequency of preoperative last seen well time in perioperative stroke patients who are identified after postoperative day one, delayed stroke recognition may contribute to the bimodal distribution in timing of perioperative stroke. Frequent neurological monitoring within 24 hours after CABG or isolated valve surgery should be considered for all patients undergoing cardiac surgery, particularly elderly patients and those with a history of stroke or thoracic aorta disease, to improve early stroke recognition.

Introduction: Previous studies have suggested that perioperative stroke (PS) following cardiac surgery has a bimodal distribution of timing with more than half of cases identified beyond postoperative day one (POD1). The objective of our multicenter study was to determine preoperative and intraoperative factors that are associated with PS following cardiac surgery and to identify factors that may contribute to PS that is identified after POD1. Methods: Patients undergoing coronary artery bypass surgery (CABG) or isolated valve surgery from January 2, 2015 to April 28, 2017 at three Southeastern US centers were identified from the Society of Thoracic Surgeons (STS) Registry. Multivariable logistic regression analysis was employed to identify preoperative (patient-related) and intraoperative (procedure-related) variables from the registry to identify factors associated with PS, defined by STS as any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain that did not resolve within 24 hours and occurring within 30 days of surgery. Neurologists performed retrospective chart review on PS patients to determine last seen well time and mechanism of stroke. Results: During the study period, 2795 patients underwent cardiac surgery (mean age 64 ± 11 years, 71% male, 71% Caucasian, 9% history of stroke) of which 43 (1.5%) had a PS; 31 (72%) patients had an embolic mechanism of stroke based on neuroimaging. In multivariable analysis, PS was independently associated with increasing age (OR 1.04, 95% 1.01-1.07), history of stroke (OR 2.73, 95% CI 1.47-5.06), and history of thoracic aorta disease (OR 3.36, 95% CI 1.16-9.71). Strokes were identified after POD1 in 32 (74%) patients, 26 (81%) of which had a preoperative last seen well time. Conclusion: Given the high frequency of pre operative last seen well times in PS patients who are identified after POD1, delayed stroke recognition may contribute to the bimodal distribution in timing of PS; frequent neurological monitoring within 24 hours of surgery should be considered for patients who are elderly, have a history of stroke or thoracic aorta disease to improve early stroke recognition.