Projects

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.