Covert stroke after non-cardiac surgery: a prospective cohort study
M Mrkobrada, M D Hill, M T V Chan, A Sigamani, D Cowan, A Kurz, D I Sessler, M Jacka, M Graham, M Dasgupta, V Dunlop, D J Emery, I Gulka, G Guyatt, D Heels-Ansdell, J Murkin, S Pettit, D J Sahlas, M Sharma, M Sharma, S Srinathan, P St John, S Tsai, A W Gelb, M O'Donnell, D Siu, P W Y Chiu, V Sharath, A George, P J Devereaux, M Mrkobrada, M D Hill, M T V Chan, A Sigamani, D Cowan, A Kurz, D I Sessler, M Jacka, M Graham, M Dasgupta, V Dunlop, D J Emery, I Gulka, G Guyatt, D Heels-Ansdell, J Murkin, S Pettit, D J Sahlas, M Sharma, M Sharma, S Srinathan, P St John, S Tsai, A W Gelb, M O'Donnell, D Siu, P W Y Chiu, V Sharath, A George, P J Devereaux
Abstract
Background: Overt stroke after non-cardiac surgery has a substantial impact on the duration and quality of life. Covert stroke in the non-surgical setting is much more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac, non-carotid artery surgery.
Methods: We undertook a prospective, international cohort study to determine the incidence of covert stroke after non-cardiac, non-carotid artery surgery. Eligible patients were ≥65 yr of age and were admitted to hospital for at least three nights after non-cardiac, non-carotid artery surgery. Patients underwent a brain magnetic resonance study between postoperative days 3 and 10. The main outcome was the incidence of perioperative covert stroke.
Results: We enrolled a total of 100 patients from six centres in four countries. The incidence of perioperative covert stroke was 10.0% (10/100 patients, 95% confidence interval 5.5-17.4%). Five of the six centres that enrolled patients reported an incident covert stroke, and covert stroke was found in patients undergoing major general (3/27), major orthopaedic (3/41), major urological or gynaecological (3/22), and low-risk surgery (1/12).
Conclusions: This international multicentre study suggests that 1 in 10 patients ≥65 yr of age experiences a perioperative covert stroke. A larger study is required to determine the impact of perioperative covert stroke on patient-important outcomes.
Clinical trial registration: NCT01369537.
Keywords: magnetic resonance imaging; perioperative period; stroke.
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Source: PubMed