The Hospital of University of Pennsylvania (HUP) performed a retrospective analysis of data to determine what effect post-operative stroke following cardiac surgery had on hospital length of stay. In this matched cohort study of patients who underwent cardiothoracic surgery at HUP’s tertiary referral center, strokes were identified over a 26-month period ending in October 2019. Surgical patients without stroke were matched by procedure and age. 44 stroke patients and 568 matched non-stroke controls were identified.
Procedures, stroke severity, and death
Of the 44 post-cardiac-surgery strokes identified, 12 strokes occurred after ascending aortic repair alone. The complete list includes:
- CABG: 2
- Lone AVR or MVR: 4
- CABG + valve replacement: 3
- Ascending aortic repair: 12
- Ascending aortic repair + AVR: 1
- Transcatheter AVR: 3
- Heart transplant: 3
- ECMO: 6
- LVAD: 3
- Lung transplant: 2
- Descending thoracic aortic stent: 4
- Descending thoracic aortic hybrid open surgery + stent: 1
Strokes were severe with a median NIHSS of 18. Mortality was associated with higher fatality: the median score for those who died was 30, the median for survivors was 16. In-hospital fatality for patients who had a stroke was 25%, while 9.5% of non-stroke patients died in-hospital.
Length of Stay (LOS) and Discharge
Stroke significantly increased ICU LOS and overall LOS. Days in ICU for stroke patients ranged from 7 to 32 days, with a median of 17. Non-stroke patients’ ICU stay ranged from 1 to 7 days, with a median of only 2 days in ICU.
Overall LOS for stroke patients ranged from 14 t0 54 days, with a median of 26; non-stroke patients’ LOS ranged from 5 to 17 days, with a median of only 8 days.
In addition to the significantly greater LOS, the patients who suffered strokes after cardiac surgery were significantly less likely to be discharged home than non-stroke cardiac surgery patients: 11% vs. 63%.
Conclusion
This study clearly indicated a significant increase in hospital resources dedicated to post-operative stroke patients following cardiac surgery. Excluding patients who died (as death may shorten LOS), stroke severity and ICU LOS were associated with both total and ICU LOS in univariable linear regression. Every 1.0 point increase in NIHSS was associated with 1.1 additional hospital days. This length of stay included significant time in ICU, with the vast majority of stroke patients being too debilitated to be discharged home.
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