ADVERSE CEREBRAL OUTCOMES AFTER CORONARY-BYPASS SURGERY

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a mult icenter study to determine the incidence and predictors of - and the u se of resources associated with - perioperative adverse neurologic eve nts, including cerebral injury. Methods In a prospective study, we eva luated 2108 patients from 24 U.S. institutions for two general categor ies of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurolog ic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had ty pe II outcomes (55 had deterioration of intellectual function and 8 ha d seizures). Patients with adverse cerebral outcomes had higher in-hos pital mortality (21 percent of patients with type I outcomes died, vs. 10 percent of those with type II and 2 percent of those with no adver se cerebral outcome; P<0.001 for all comparisons), longer hospitalizat ion (25 days with type I outcomes, 21 days with type II, and 10 days w ith no adverse outcome; P<0.001), and a higher rate of discharge to fa cilities for intermediate- or long-term care (47 percent, 30 percent, and 8 percent; P<0.001). Predictors of type I outcomes were proximal a ortic atherosclerosis, a history of neurologic disease, and older age; predictors of type II outcomes were older age, systolic hypertension on admission, pulmonary disease, and excessive consumption of alcohol. Conclusions Adverse cerebral outcomes after coronary bypass surgery a re relatively common and serious; they are associated with substantial increases in mortality, length of hospitalization, and use of interme diate- or Iong-term care facilities. New diagnostic and therapeutic st rategies must be developed to lessen such injury.