M Mrkobrada1, M D Hill2, M T V Chan3, A Sigamani4, D Cowan5, A Kurz6, D I Sessler6, M Jacka7, M Graham7, M Dasgupta8, V Dunlop9, D J Emery7, I Gulka10, G Guyatt5, D Heels-Ansdell5, J Murkin8, S Pettit9, D J Sahlas5, M Sharma8, M Sharma8, S Srinathan11, P St John11, S Tsai12, A W Gelb13, M O'Donnell5, D Siu3, P W Y Chiu3, V Sharath4, A George4, P J Devereaux5. 1. University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5 mmrkobr@uwo.ca. 2. University of Calgary, Calgary, AB, Canada. 3. Chinese University of Hong Kong, Hong Kong, SAR, China. 4. St John's Medical College and St John's Research Institute, Bangalore, India. 5. McMaster University, Hamilton, ON, Canada. 6. Cleveland Clinic, Cleveland, OH, USA. 7. University of Alberta Hospital, Edmonton, AB, Canada. 8. University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5. 9. Population Health Research Institute, Hamilton, ON, Canada. 10. London Health Sciences, London, ON, Canada. 11. University of Manitoba, Winnipeg, MB, Canada. 12. Hamilton Health Sciences, Hamilton, ON, Canada. 13. University of California, San Francisco, CA, USA.
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.
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.
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