Covert perioperative strokes in older patients having non-cardiac surgery (PRECISION): a prospective cohort analysis.

Autor:	Cui Q; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Zhao W; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Chen H; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Ren Y; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Yin X; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Zheng M; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Li M; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Wang J; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Wang J; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Zeng M; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Li S; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China., Zhang K; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Wu X; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Zhou L; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Jiao Y; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Sessler DI; Center for Outcomes Research and Department of Anesthesiology, UTHealth, Houston, Texas., Mi W; Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, Beijing, P.R China., Peng Y; Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China.; Outcomes Research Consortium , Houston, Texas.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2024 Dec 19. Date of Electronic Publication: 2024 Dec 19.
DOI:	10.1097/ALN.0000000000005327
Abstrakt:	Background: Perioperative 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. Methods: PRECISION 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. Results: Among 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. Conclusions: One 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. Competing Interests: Conflicts of Interest The authors declare no competing interest. (Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
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