Impact of stroke on outcomes following cardiac surgery: Propensity matched analysis.

BACKGROUND: Stroke remains a devastating complication of cardiac surgery. The aim of this study was to characterize the incidence of stroke and analyze the impact of stroke on patient outcomes and survival. METHODS: A retrospective analysis was performed of patients with a computed tomography-confirmed stroke diagnosis between 1 January 2015 and 31 March 2019 at a single center. 2:1 propensity matching was performed to identify a control population. RESULTS: Over the period 165 patients suffered a stroke (1.99%), with an incidence ranging from 0.85% for coronary artery bypass grafting to 8.14% for aortic surgery. The mean age was 70.3 years and 58.8% were male. 18% had experienced a previous stroke or transient ischemic attack. Compared to the comparison group, patients experiencing postoperative stroke had a significantly prolonged period of intensive care unit admission (8.0 vs 1.1 days P < .001) and hospital length of stay (12.94 vs 8.0 days P < .001). Patient survival was also inferior. In-hospital mortality was almost three times as high (17.0% vs 5.9%; P < .001). Longer-term survival was also inferior to Kaplan-Meier estimation (P < .001). The 1-year and 3-year survival were 61.5% and 53.8% respectively compared to 89.4% and 86.1% for the comparison group. CONCLUSION: Perioperative stroke is a devastating complication following cardiac surgery. Perioperative stroke is associated with significantly inferior outcomes in terms of both morbidity and mortality. Notably a 28% reduction in 1-year survival. Efforts should focus on identifying strategies aimed at reducing the incidence, morbidity, and mortality of perioperative stroke following cardiac surgery.

Debridement alone without decortication can achieve lung re-expansion in patients with empyema: an observational study.

Decortication is widely performed for empyema, but the effectiveness in achieving lung re-expansion has never been formally reported. The aim of this study is to quantify the degree of lung re-expansion in comparison to that achieved naturally after debridement alone. A retrospective review of patients who underwent either decortication or debridement for empyema between 2007 and 2009. The change of the cavity size with time were standardized and recorded before, immediately after surgery and on follow-up. Of 25 patients who underwent surgical management of empyema, 16 (64%) underwent debridement alone and nine (36%) underwent decortication. The mean age (standard deviation) was 58 (19) years and 15 (60%) were male. On radiological follow-up at a median [interquartile range (IQR)] of 45 (36-116) days, further reduction of 36% and 34% was achieved leaving 27% and 12% of the original cavity size in the debridement and decortication groups, respectively. Procedure (debridement or decortication) was not associated with any difference to the eventual follow-up cavity size (P = 0.937). Similar follow-up results were achieved by debridement alone without decortication in patients presenting with empyema, despite the presence of an underlying trapped lung.

Breathlessness after pneumonectomy: consider postpneumonectomy syndrome.

A 59-year-old woman presented with increasing breathlessness several weeks after right pneumonectomy. Imaging confirmed features of postpneumonectomy syndrome with marked mediastinal shift, and compression of the left main bronchus and pulmonary vein. The mediastinum was repositioned by insertion of saline-filled prostheses into the pneumonectomy space with symptomatic and radiologic improvement. Clinicians caring for patients after pneumonectomy should be aware of this rare but treatable complication.