Key result
Perioperative covert stroke is linked to one-year cognitive decline after non-cardiac surgery.
Why the study?
Little is known about covert stroke after non-cardiac surgery and its association with postoperative cognitive function.
Does acute perioperative covert stroke increase the risk of postoperative cognitive dysfunction at 1 year in patients aged ≥65 years undergoing elective non-cardiac surgery?
Cohort
Blinded to MRI results
Yes
Does acute perioperative covert stroke increase the risk of postoperative cognitive dysfunction at 1 year in patients aged ≥65 years undergoing elective non-cardiac surgery?
The NeuroVISION study will be the largest prospective cohort study to characterize the incidence of perioperative covert stroke and its association with cognitive decline 1 year after non-cardiac surgery.
Covert stroke after non-cardiac surgery was associated with cognitive decline; leaves open whether targeted prevention improves long-term outcomes.
OBJECTIVES: Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is 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 surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function. SETTING AND PARTICIPANTS: We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents. PARTICIPANTS: We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction. CONCLUSIONS: The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery. TRIAL REGISTRATION NUMBER: NCT01980511; Pre-results.
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Mrkobrada et al. (2018) conducted a cohort in Non-cardiac surgery. Perioperative acute covert stroke vs. No perioperative acute covert stroke was evaluated on Postoperative cognitive dysfunction (decrease of ≥2 points on MoCA scale from baseline to 1 year). The NeuroVISION study is a prospective international cohort study designed to characterize the incidence of covert stroke after non-cardiac surgery and its association with cognitive decline at 1 year.
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