Covert Perioperative Strokes in Older Patients Having Noncardiac Surgery (PRECISION): A Prospective Cohort Analysis

作者：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, Yuming Peng · 发表于：Anesthesiology · 年份：2024 · DOI：10.1097/aln.0000000000005327 · 被引用次数：22 · 研究领域：Intensive Care Unit Cognitive Disorders、Cardiac, Anesthesia and Surgical Outcomes、Anesthesia and Sedative Agents

BACKGROUND: Perioperative strokes may promote postoperative neurocognitive dysfunction. This study thus evaluated the incidence of postoperative strokes and the association between strokes and postoperative neurocognitive outcomes in older patients recovering from noncardiac surgery. METHODS: The Postoperative Covert Stroke and Cognitive Dysfunction among Elderly Patients Undergoing Noncardiac Surgery study (PRECISION) was a two-center prospective cohort study evaluating patients aged 60 yr or older who had elective, noncardiac inpatient surgery at two Chinese academic centers. Postoperative strokes were evaluated by scheduled magnetic resonance brain imaging within 7 days. The 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 yr; 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 was observed in 147 patients (18.8%; 95% CI, 16.0 to 21.5%) at 1 yr after surgery. Postoperative covert strokes were significantly associated with delirium (adjusted odds ratio, 2.18; 95% C...