Covert stroke after non-cardiac surgery: a prospective cohort study

Br J Anaesth. 2016 Aug;117(2):191-7. doi: 10.1093/bja/aew179.


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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Brain / diagnostic imaging*
  • Brain / pathology
  • Cohort Studies
  • Female
  • Humans
  • Internationality
  • Magnetic Resonance Imaging*
  • Male
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / pathology
  • Prospective Studies
  • Risk
  • Stroke / diagnostic imaging*
  • Stroke / pathology

Associated data