Context

In non-surgical settings, hidden stroke is more common than overt stroke and is associated
with cognitive decline. Although stroke occurs in less than 1% of adults after
noncardiac surgery and is associated with substantial morbidity we know little about
secretive perioperative stroke. Therefore, our main goal was to study the relationship
perioperative secretive stroke (ie, acute cerebral infarction detected on MRI).
after non-cardiac surgery in a patient with no clinical symptoms of stroke) and cognitive.
decline 1 year after surgery.

The methods

NeuroVISION was a prospective cohort study conducted at 12 academic centers in nine countries.
in which we evaluated patients aged 65 or older who had been hospitalized, an elective,
non-cardiac surgery and had a brain MRI after the surgery. Two independent neuroradiology
Experts, masked by clinical data, evaluated each MRI for acute cerebral infarction. Using
multivariable regression, we explored the link between hidden stroke and the
result of cognitive decline, defined as a decrease of 2 points or more on
Montreal cognitive assessment from preoperative onset to one-year follow-up.
Patients, health care providers and outcome evaluators were masked by MRI results.

Results

Between March 24, 2014 and July 21, 2017, out of 1114 participants recruited in the study,
78 (7%, 95% CI 6-9) had a perioperative secretive stroke. Of the patients who completed
1-year follow-up, cognitive decline 1 year after surgery at 29 (42%)
of 69 participants who had a perioperative discrete stroke and 274 (29%) of the 932 participants
who had not suffered a perioperative secret stroke (adjusted odds ratio of 1.98, 95% CI: 1.22-23.20,
absolute risk increase of 13%; p = 0.005). Hidden stroke has also been associated with an increase
risk of perioperative delirium (risk ratio [HR] 2 · 24, 95% CI 1 · 06-4 · 73, absolute
risk increase of 6%; p = 0.030) and overt stroke or transient ischemic attack at 1 year
follow-up (HR 4 · 13, 1 · 14-14 · 99, absolute risk increase of 3%, p = 0.01).

Interpretation

Secret perioperative stroke is associated with increased risk of cognitive decline
One year after noncardiac surgery, and a perioperative secretive stroke occurred in a
in 14 patients aged 65 years and over undergoing non-cardiac surgery. The search is
necessary to establish prevention and management strategies for perioperative secret interventions.
stroke.

Funding

Canadian Institutes of Health Research; Ontario's Patient Strategy
Research Support Unit; Ontario Ministry of Health and Long-Term Care; Health and
Medical Research Fund, Hong Kong Government Special Administrative Region,
China; and the Neurological Foundation of New Zealand.