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Encephalopathy and Stroke After Coronary Artery Bypass Grafting
Incidence, Consequences, and Prediction
Guy M. McKhann, MD;
Maura A. Grega, MSN;
Louis M. Borowicz, Jr, MS;
Michon Bechamps, MHS;
Ola A. Selnes, PhD;
William A. Baumgartner, MD;
Richard M. Royall, PhD
Arch Neurol. 2002;59:1422-1428.
Background In contrast to perioperative stroke, much less attention has been paid
to those with evidence of diffuse brain encephalopathy, presenting as delirium,
confusion, coma, and seizures in the immediate postoperative period.
Objective To determine the incidence, consequences, and predictive factors for
encephalopathy and stroke following coronary artery bypass grafting.
Methods In a prospective evaluation of 2711 patients operated on between January
1, 1997, and December 31, 2000, preoperative risk factors were obtained before
surgery and postoperative outcomes, encephalopathy and stroke, were determined
on a daily basis. All strokes were confirmed by neurologic consultation and,
in most instances, by imaging. Logistic regression analyses were performed
to determine risk factors for these outcomes.
Results The incidence of encephalopathy was 6.9% and of stroke, 2.7%. For patients
without either of these outcomes, the average length of stay in the hospital
was 6.6 days and the mortality was 1.4%. In contrast, patients with encephalopathy
had a length of stay of 15.2 days and a mortality of 7.5%, and those with
stroke, a length of stay of 17.5 days and a mortality of 22.0%. Predictive
models were developed for encephalopathy involving 5 preoperative factors
(age, past stroke, carotid bruit, hypertension, and diabetes) and 1 perioperative
factor (time on cardiopulmonary bypass). The model for stroke involved only
3 preoperative risk factors (past stroke, hypertension, and diabetes).
Conclusions Encephalopathy or stroke is associated with significant increases in
length of stay and mortality after coronary artery bypass grafting. Patients
at higher risk for these outcomes can be identified before surgery.
From the Department of Neurology (Drs McKhann and Selnes), Division
of Cardiac Surgery, Department of Surgery (Ms Grega and Dr Baumgartner), and
Department of Neuroscience (Dr McKhann), Johns Hopkins School of Medicine;
the Zanvyl Krieger Mind/Brain Institute (Dr McKhann and Mr Borowicz); and
the Department of Biostatistics, The Johns Hopkins University Bloomberg School
of Public Health (Dr Royall), The Johns Hopkins University, Baltimore, Md;
and the MD Program, Eastern Virginia Medical School, Norfolk (Ms Bechamps).
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