Department of Anesthesiology& Pain Management, The University of Texas Southwestern, Dallas, TX, USA.
Department of Anesthesiology& Pain Management, The University of Texas Southwestern, Dallas, TX, USA; The Department of Cardiovascular Surgery, The University of Texas Southwestern, Dallas, TX, USA.
J Stroke Cerebrovasc Dis. 2023 May;32(5):107057. doi: 10.1016/j.jstrokecerebrovasdis.2023.107057. Epub 2023 Mar 9.
In-hospital stroke mortality is surprisingly much worse than for strokes occurring outside of the hospital. Cardiac surgery patients are amongst the highest risk groups for in-hospital stroke and experience high stroke-related mortality. Variability in institutional practices appears to play an important role in the diagnosis, management, and outcome of postoperative stroke. We therefore tested the hypothesis that variability in postoperative stroke management of cardiac surgical patients exists across institutions.
A 13 item survey was employed to determine postoperative stroke practice patterns for cardiac surgical patients across 45 academic institutions.
Less than half (44%) reported any formal clinical effort to preoperatively identify patients at high risk for postoperative stroke. Epiaortic ultrasonography for the detection of aortic atheroma, a proven preventative measure, was routinely practiced in only 16% of institutions. Forty-four percent (44%) reported not knowing whether a validated stroke assessment tool was utilized for the detection of postoperative stroke, and 20% reported that validated tools were not routinely used. All responders, however, confirmed the availability of stroke intervention teams.
Adoption of a best practices approach to the management of postoperative stroke is highly variable and may improve outcomes in postoperative stroke after cardiac surgery.
院内卒中死亡率令人惊讶地远高于院外卒中。心脏手术患者是院内卒中风险最高的人群之一，其卒中相关死亡率较高。机构实践中的差异似乎在术后卒中的诊断、管理和结果中起着重要作用。因此，我们检验了这样一个假设，即在心脏外科患者的术后卒中管理方面，各机构之间存在差异。
采用 13 项调查来确定 45 家学术机构中心脏外科患者的术后卒中实践模式。
不到一半（44%）的机构报告说，有任何术前识别术后卒中高危患者的正式临床努力。虽然主动脉外超声检查（一种已被证实的预防措施）在只有 16%的机构中常规进行，但仍有 44%的机构报告说不知道是否使用了经验证的卒中评估工具来检测术后卒中，20%的机构报告说没有常规使用经验证的工具。然而，所有的应答者都确认了卒中干预团队的可用性。
采用最佳实践方法来管理术后卒中的方法差异很大，可能会改善心脏手术后的术后卒中结果。
