title: Covert stroke after non-cardiac surgery: a prospective cohort study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  NCT01369537.
authors.affiliation: University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5 mmrkobr@uwo.ca.
authors.forename: M
authors.initials: M
authors.lastname: Mrkobrada
authors.affiliation: University of Calgary, Calgary, AB, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Chinese University of Hong Kong, Hong Kong, SAR, China.
authors.forename: M T V
authors.initials: MT
authors.lastname: Chan
authors.affiliation: St John's Medical College and St John's Research Institute, Bangalore, India.
authors.forename: A
authors.initials: A
authors.lastname: Sigamani
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cowan
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kurz
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Jacka
authors.affiliation: University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Graham
authors.affiliation: University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5.
authors.forename: M
authors.initials: M
authors.lastname: Dasgupta
authors.affiliation: Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Dunlop
authors.affiliation: University of Alberta Hospital, Edmonton, AB, Canada.
authors.forename: D J
authors.initials: DJ
authors.lastname: Emery
authors.affiliation: London Health Sciences, London, ON, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Gulka
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Heels-Ansdell
authors.affiliation: University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5.
authors.forename: J
authors.initials: J
authors.lastname: Murkin
authors.affiliation: Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Pettit
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sahlas
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sharma
authors.affiliation: University of Western Ontario, 339 Windermere Road B9-100, London, ON, Canada N6A 5A5.
authors.forename: M
authors.initials: M
authors.lastname: Sharma
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Srinathan
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: P
authors.initials: P
authors.lastname: St John
authors.affiliation: Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Tsai
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Gelb
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Chinese University of Hong Kong, Hong Kong, SAR, China.
authors.forename: D
authors.initials: D
authors.lastname: Siu
authors.affiliation: Chinese University of Hong Kong, Hong Kong, SAR, China.
authors.forename: P W Y
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: St John's Medical College and St John's Research Institute, Bangalore, India.
authors.forename: V
authors.initials: V
authors.lastname: Sharath
authors.affiliation: St John's Medical College and St John's Research Institute, Bangalore, India.
authors.forename: A
authors.initials: A
authors.lastname: George
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D038622:Internationality; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012306:Risk; D020521:Stroke / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: magnetic resonance imaging; perioperative period; stroke