Abstract TP120: The Impact Of Stroke On Cost And Length Of Stay After Cardiac Surgery.

Introduction: Stroke after cardiac surgery is associated with poor outcome but there are limited data on the impact on cost and length of stay (LOS). Methods: We performed a retrospective matched cohort study of patients who underwent cardiothoracic surgery at our tertiary referral center, identifying 44 strokes and 568 non-stroke controls matched by procedure and age (within 5 years of the max and min of stroke patients). Stroke severity was assessed by NIHSS. Results: The cohorts were well-matched, 34% of the stroke patients were female, compared to 37% of controls without stroke, p=0.71. Patients with stroke were younger than patients without stroke, median 68 vs 74 years, p=0.008. Strokes were severe, median NIHSS was 18 (interquartile range [IQR] 9 - 29). Patients with stroke had a higher risk of in-hospital mortality, 25% vs 9.5%%, OR 3.2, 95% CI 1.5 - 6.6, p=0.002 and were less likely to be discharged home 11% vs 63%, OR 0.06, 05% CI 0.02 - 0.016, p<0.0001. Mortality was associated with higher stroke severity, with median NIHSS 30 for patients who died compared to 16 for survivors, p=0.005. Stroke was associated with large increases in direct and indirect costs, as well as LOS (Table). Excluding patients who died (which may shorten LOS), stroke severity was associated with both total and ICU LOS in univariable linear regression: Every 1-point increase in NIHSS was associated with 1.1 additional hospital days (95%CI 0.1 - 2.1 days), p=0.03, including 0.8 days (95%CI 0.2 - 1.5 days) in the ICU, p=0.01. Conclusions: Stroke complicating cardiac surgery is associated with enormous increases in cost and length of stay, which is related to stroke severity.