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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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