Intraoperative Neurophysiologic Monitoring Predicts Postoperative Stroke and Mortality after Routine Cardiac Surgery
James Brown, Sarah Yousef, Derek Serna-Gallegos, Jianhui Zhu, Pyongsoo Yoon, David Kaczorowski, Johannes Bonatti, Danny Chu, Parthasarathy Thirumala, Jeffrey Balzer, Ibrahim Sultan.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background: To evaluate the ability of intraoperative neurophysiologic monitoring (IONM) during routine cardiac surgery to predict postoperative stroke and mortality. Methods: This was an observational study of coronary and/or valvular heart operations from 2010-2021. Baseline characteristics and postoperative outcomes were compared by the use or nonuse of IONM, which included both electroencephalography (EEG) and somatosensory-evoked potentials (SSEP). Multivariable logistic regression was employed to assess the association of IONM usage with operative mortality and stroke. Results: A total of 19,299 patients underwent cardiac surgery, of which 589 (3.1%) had IONM, while 18,710 (96.9%) did not. Mean age was 65.8 ± 11.9, 32% were female, and 94% were white. Patients with IONM were more likely to have had baseline cerebrovascular disease (60% vs. 22%) than patients without IONM (p<0.001). Patients with IONM had increased operative mortality (5.3% vs. 2.5%) and a higher stroke rate (4.9% vs. 1.9%) than patients without IONM. Moreover, stroke and mortality were highly correlated, with 14% of strokes resulting in death, while only 2% of non-strokes resulted in death (p<0.001). On multivariable analysis, IONM usage was correlated with postoperative stroke (OR 2.05, 95% CI: 1.37, 3.07, p<0.001, Table) and operative mortality (OR 1.84, 95% CI: 1.24, 2.73, p<0.001, Table). On subgroup analysis, these relationships between IONM usage and postoperative stroke and mortality persisted when only considering patients with cerebrovascular disease. Conclusions: IONM may portend worse neurologic outcomes and operative mortality after routine cardiac surgery; therefore, IONM ought to be utilized for patients at high risk for stroke.
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