Publications
Covert stroke after non-cardiac surgery: a prospective cohort study
M. Mrkobrada1,*, M. D. Hill2, M. T. V. Chan3, A. Sigamani4, D. Cowan5, A. Kurz6, D. I. Sessler6, M. Jacka7, M. Graham7, M. Dasgupta1, V. Dunlop8, D. J. Emery7, I. Gulka9, G. Guyatt5, D. Heels-Ansdell5, J. Murkin1, S. Pettit8, D. J. Sahlas5, M. Sharma5, M. Sharma1, S. Srinathan10, P. St John10, S. Tsai11, A. W. Gelb12, M. O’Donnell5, D. Siu3, P. W. Y. Chiu3, V. Sharath4, A. George4 and P. J. Devereaux5 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.