Objective

Neurological complications following cardiac surgery have a high in-hospital mortality and morbidity associated with it. The UK does not have a scoring system to predict such complications. Furthermore, little long-term data exists for survival from stoke, transient ischaemic attacks (TIAs) and acute delirium following cardiac surgery. We therefore looked at the long-term effects of neurological complications as well as developed and validated a scoring system to predict such complications.

Methods

Retrospective analysis of data collected prospectively on our cardiac database between July 1999 and March 2015. A multivariate logistic regression model was used to create a prediction model and the model was then validated. Long-term survival was evaluated using the Kaplan-Meier method.

Results

In total, 13,655 consecutive patients underwent cardiac surgery. Permanent stroke occurred in 1.1% of patients, acute delirium in 2.2% and TIAs in 1.1%. The validation for the final logistic regression model for permanent stroke showed a c-index of 0.717. The long-term survival (2, 5, 10 & 15 years) was significantly less (p<0.05, log-rank) in those who survived stroke, TIA and acute delirium at hospital discharge compared to those discharged who did not sustain these pathologies.

Conclusion

Post-operative stroke and acute delirium carries a poor long-term survival. We have developed a risk score to predict these neurological outcomes which will help identify those patients at the highest risk so they can be thoroughly counselled and optimised pre-operatively and that our annual resource allocation can be planned.