TY - JOUR
T1 - Intraoperative physiologic variables and outcome in cardiac surgery
T2 - Part II. Neurologic outcome
AU - Van Wermeskerken, Gijs K.
AU - Lardenoye, Jan Willem H.
AU - Hill, Steven E.
AU - Grocott, Hilary P.
AU - Phillips-Bute, Barbara
AU - Smith, Peter K.
AU - Reves, Joseph G.
AU - Newman, Mark F.
PY - 2000/4
Y1 - 2000/4
N2 - Background. The impact of alterable physiologic variables on neurologic outcome after coronary artery bypass grafting procedures is unknown. The purpose of this study was to determine whether minimum intraoperative hematocrit, maximum glucose concentration, or mean arterial pressure during cardiopulmonary bypass influences risk-adjusted neurologic outcome after coronary artery bypass grafting. Methods. Outcome data from 2,862 patients undergoing coronary artery bypass grafting were merged with intraoperative physiologic data. A preoperative stroke risk index was calculated for each patient. Variables found significant by univariate logistic regression were tested in a multivariable model to determine association with outcome. Results. The incidence of stroke or coma in the study population was 1.3%. After controlling for stroke risk and bypass time, only an index of low mean arterial pressure during bypass retained a significant inverse association with outcome (p = 0.0304). Conclusions. This study found no evidence that glucose concentration or minimum hematocrit are associated with major adverse neurologic outcome. The association between lower pressure during bypass and decreased incidence of stroke or coma persisted in all risk groups. This points to mechanisms other than hypoperfusion as the primary cause of neurologic injury associated with cardiac surgery. (C) 2000 by The Society of Thoracic Surgeons.
AB - Background. The impact of alterable physiologic variables on neurologic outcome after coronary artery bypass grafting procedures is unknown. The purpose of this study was to determine whether minimum intraoperative hematocrit, maximum glucose concentration, or mean arterial pressure during cardiopulmonary bypass influences risk-adjusted neurologic outcome after coronary artery bypass grafting. Methods. Outcome data from 2,862 patients undergoing coronary artery bypass grafting were merged with intraoperative physiologic data. A preoperative stroke risk index was calculated for each patient. Variables found significant by univariate logistic regression were tested in a multivariable model to determine association with outcome. Results. The incidence of stroke or coma in the study population was 1.3%. After controlling for stroke risk and bypass time, only an index of low mean arterial pressure during bypass retained a significant inverse association with outcome (p = 0.0304). Conclusions. This study found no evidence that glucose concentration or minimum hematocrit are associated with major adverse neurologic outcome. The association between lower pressure during bypass and decreased incidence of stroke or coma persisted in all risk groups. This points to mechanisms other than hypoperfusion as the primary cause of neurologic injury associated with cardiac surgery. (C) 2000 by The Society of Thoracic Surgeons.
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U2 - 10.1016/S0003-4975(99)01443-5
DO - 10.1016/S0003-4975(99)01443-5
M3 - Article
C2 - 10800797
AN - SCOPUS:0034066551
SN - 0003-4975
VL - 69
SP - 1077
EP - 1083
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -