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- Qianyu Cui, Weixing Zhao, Hongyan Chen, Yue Ren, Xueke Yin, Maoyao Zheng, Muhan Li, Jie Wang, Juan Wang, Min Zeng, Shu Li, Kai Zhang, Xiaodong Wu, Liye Zhou, Youyou Jiao, Daniel I Sessler, Weidong Mi, and Yuming Peng.
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China.
- Anesthesiology. 2024 Dec 19.
BackgroundPerioperative strokes may promote postoperative neurocognitive dysfunction. We thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from non-cardiac surgery.MethodsPRECISION was a two-center prospective cohort study. We evaluated patients aged ≥60 years who had elective, non-cardiac inpatient surgery at two Chinese academic centers. Postoperative strokes were evaluated by scheduled magnetic resonance brain imaging within 7 days. Our primary outcome was the cumulative incidence of postoperative stroke. Secondary outcomes included postoperative delirium within the first 5 days after surgery, neurocognitive decline at 12 months and the association between stroke and neurocognitive dysfunction.ResultsAmong 934 patients (mean age, 67 years; 45% male) included in the analyses, two-thirds had neurosurgical craniotomies. There were 111 (11.9%, 95% CI 9.8% to 14.0%) covert strokes within 7 days after surgery, and no overt strokes. Postoperative delirium was observed in 117 patients (12.5%, 95% CI 10.4% to 14.7%) within 5 days and neurocognitive decline observed in 147 patients (18.8%, 95%CI 16.0% to 21.5%) at 1 year after surgery. Postoperative covert strokes were significantly associated with delirium (adjusted odds ratio 2.18, 95% CI 1.31 to 3.62; P=0.003), and 1-year neurocognitive decline (adjusted OR 2.33, 95% CI 1.31 to 4.13, P=0.004) in overall participants.ConclusionsOne in 9 patients aged 60 years and older who had major non-cardiac surgery, mainly intracranial, experienced a perioperative covert stroke. Covert strokes more than doubled the risk of postoperative delirium and long-term neurocognitive decline. Covert perioperative strokes are common and clinically meaningful.Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.
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