Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome

Gijs K. Van Wermeskerken, Jan Willem H Lardenoye, Steven E. Hill, Hilary P. Grocott, Barbara Phillips-Bute, Peter K. Smith, Joseph G. Reves, Mark F. Newman

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1077-1083
Number of pages7
JournalAnnals of Thoracic Surgery
Volume69
Issue number4
DOIs
StatePublished - Apr 2000

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Nervous System
Thoracic Surgery
Stroke
Coronary Artery Bypass
Coma
Hematocrit
Arterial Pressure
Nervous System Trauma
Glucose
Incidence
Cardiopulmonary Bypass
Logistic Models
Pressure
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Van Wermeskerken, G. K., Lardenoye, J. W. H., Hill, S. E., Grocott, H. P., Phillips-Bute, B., Smith, P. K., ... Newman, M. F. (2000). Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome. Annals of Thoracic Surgery, 69(4), 1077-1083. https://doi.org/10.1016/S0003-4975(99)01443-5

Intraoperative physiologic variables and outcome in cardiac surgery : Part II. Neurologic outcome. / Van Wermeskerken, Gijs K.; Lardenoye, Jan Willem H; Hill, Steven E.; Grocott, Hilary P.; Phillips-Bute, Barbara; Smith, Peter K.; Reves, Joseph G.; Newman, Mark F.

In: Annals of Thoracic Surgery, Vol. 69, No. 4, 04.2000, p. 1077-1083.

Research output: Contribution to journalArticle

Van Wermeskerken, GK, Lardenoye, JWH, Hill, SE, Grocott, HP, Phillips-Bute, B, Smith, PK, Reves, JG & Newman, MF 2000, 'Intraoperative physiologic variables and outcome in cardiac surgery: Part II. Neurologic outcome', Annals of Thoracic Surgery, vol. 69, no. 4, pp. 1077-1083. https://doi.org/10.1016/S0003-4975(99)01443-5
Van Wermeskerken, Gijs K. ; Lardenoye, Jan Willem H ; Hill, Steven E. ; Grocott, Hilary P. ; Phillips-Bute, Barbara ; Smith, Peter K. ; Reves, Joseph G. ; Newman, Mark F. / Intraoperative physiologic variables and outcome in cardiac surgery : Part II. Neurologic outcome. In: Annals of Thoracic Surgery. 2000 ; Vol. 69, No. 4. pp. 1077-1083.
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