Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study

Marko Mrkobrada; Matthew T.V. Chan; David Cowan; Jessica Spence; Douglas Campbell; Chew Yin Wang; David Torres; German Malaga; Robert D. Sanders; Carl Brown; Alben Sigamani; Wojciech Szczeklik; Adam Andrew Dmytriw; Ronit Agid; Eric E. Smith; Michael D. Hill; Manas Sharma; Mukul Sharma; Scott Tsai; Arun Mensinkai; Demetrios J. Sahlas; Gordon Guyatt; Shirley Pettit; Ingrid Copland; William K.K. Wu; Simon C.H. Yu; Tony Gin; Pui San Loh; Norlisah Ramli; Yee Lein Siow; Timothy G. Short; Ellen Waymouth; Jonathan Kumar; Monidipa Dasgupta; John M. Murkin; Maite Fuentes; Victor Ortiz-Soriano; Heidi Lindroth; Sara Simpson; Daniel Sessler; P. J. Devereaux

doi:10.1136/bmjopen-2018-021521

Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study

Marko Mrkobrada^*, Matthew T.V. Chan, David Cowan, Jessica Spence, Douglas Campbell, Chew Yin Wang, David Torres, German Malaga, Robert D. Sanders, Carl Brown, Alben Sigamani, Wojciech Szczeklik, Adam Andrew Dmytriw, Ronit Agid, Eric E. Smith, Michael D. Hill, Manas Sharma, Mukul Sharma, Scott Tsai, Arun MensinkaiDemetrios J. Sahlas, Gordon Guyatt, Shirley Pettit, Ingrid Copland, William K.K. Wu, Simon C.H. Yu, Tony Gin, Pui San Loh, Norlisah Ramli, Yee Lein Siow, Timothy G. Short, Ellen Waymouth, Jonathan Kumar, Monidipa Dasgupta, John M. Murkin, Maite Fuentes, Victor Ortiz-Soriano, Heidi Lindroth, Sara Simpson, Daniel Sessler, P. J. Devereaux

^*Corresponding author for this work

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8 Scopus citations

Abstract

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.

Original language	English
Article number	e021521
Journal	BMJ Open
Volume	8
Issue number	7
DOIs	https://doi.org/10.1136/bmjopen-2018-021521
State	Published - 1 Jul 2018

Bibliographical note

Funding Information:
Competing interests EES reports grants from McMaster University, during the conduct of the study. TG reports grants from Food and Health Bureau, HK government, during the conduct of the study. PJD reports grants from Abbott Diagnostics, grants from Boehringer-Ingelheim, grants from Covidien, grants from Octopharma, grants from Phillips Healthcare, grants from Roche Diagnostics, grants from Stryker, outside the submitted work. DoC reports grants from Neurological Foundation of New Zealand, during the conduct of the study. MDH reports personal fees from Merck, non-financial support from Hoffmann-La Roche Canada, grants from Covidien (Medtronic), grants from Boehringer-Ingleheim, grants from Stryke, grants from Medtronic, outside the submitted work. In addition, MDH has a patent Systems and Methods for Assisting in Decision-Making and Triaging for Acute Stroke Patients pending to US Patent office Number: 62/086,077 and owns stock in Calgary Scientific, a company that focuses on medical imaging software, is a director of the Canadian Federation of Neurological Sciences, a not-for-profit group and has received grant support from Alberta Innovates Health Solutions, CIHR, Heart and Stroke Foundation of Canada, National Institutes of Neurological Disorders and Stroke. MTVC reports grants from Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong government during the conduct of the study. TGS reports grants from New Zealand Neurological Foundation during the conduct of the study.

Funding Information:
funding This work was supported by CIHR’s Strategy for Patient-Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care; Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong Government; Auckland District Health Board Charitable Trust; Neurological Foundation of New Zealand.

Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.

Keywords

adult anaesthesia
adult surgery
stroke medicine

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10.1136/bmjopen-2018-021521

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Mrkobrada, M., Chan, M. T. V., Cowan, D., Spence, J., Campbell, D., Wang, C. Y., Torres, D., Malaga, G., Sanders, R. D., Brown, C., Sigamani, A., Szczeklik, W., Dmytriw, A. A., Agid, R., Smith, E. E., Hill, M. D., Sharma, M., Sharma, M., Tsai, S., ... Devereaux, P. J. (2018). Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study. BMJ Open, 8(7), Article e021521. https://doi.org/10.1136/bmjopen-2018-021521

@article{77036734aef043dc8905e7e07adbb006,

title = "Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study",

abstract = "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.",

keywords = "adult anaesthesia, adult surgery, stroke medicine",

author = "Marko Mrkobrada and Chan, {Matthew T.V.} and David Cowan and Jessica Spence and Douglas Campbell and Wang, {Chew Yin} and David Torres and German Malaga and Sanders, {Robert D.} and Carl Brown and Alben Sigamani and Wojciech Szczeklik and Dmytriw, {Adam Andrew} and Ronit Agid and Smith, {Eric E.} and Hill, {Michael D.} and Manas Sharma and Mukul Sharma and Scott Tsai and Arun Mensinkai and Sahlas, {Demetrios J.} and Gordon Guyatt and Shirley Pettit and Ingrid Copland and Wu, {William K.K.} and Yu, {Simon C.H.} and Tony Gin and Loh, {Pui San} and Norlisah Ramli and Siow, {Yee Lein} and Short, {Timothy G.} and Ellen Waymouth and Jonathan Kumar and Monidipa Dasgupta and Murkin, {John M.} and Maite Fuentes and Victor Ortiz-Soriano and Heidi Lindroth and Sara Simpson and Daniel Sessler and Devereaux, {P. J.}",

note = "Funding Information: Competing interests EES reports grants from McMaster University, during the conduct of the study. TG reports grants from Food and Health Bureau, HK government, during the conduct of the study. PJD reports grants from Abbott Diagnostics, grants from Boehringer-Ingelheim, grants from Covidien, grants from Octopharma, grants from Phillips Healthcare, grants from Roche Diagnostics, grants from Stryker, outside the submitted work. DoC reports grants from Neurological Foundation of New Zealand, during the conduct of the study. MDH reports personal fees from Merck, non-financial support from Hoffmann-La Roche Canada, grants from Covidien (Medtronic), grants from Boehringer-Ingleheim, grants from Stryke, grants from Medtronic, outside the submitted work. In addition, MDH has a patent Systems and Methods for Assisting in Decision-Making and Triaging for Acute Stroke Patients pending to US Patent office Number: 62/086,077 and owns stock in Calgary Scientific, a company that focuses on medical imaging software, is a director of the Canadian Federation of Neurological Sciences, a not-for-profit group and has received grant support from Alberta Innovates Health Solutions, CIHR, Heart and Stroke Foundation of Canada, National Institutes of Neurological Disorders and Stroke. MTVC reports grants from Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong government during the conduct of the study. TGS reports grants from New Zealand Neurological Foundation during the conduct of the study. Funding Information: funding This work was supported by CIHR{\textquoteright}s Strategy for Patient-Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care; Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong Government; Auckland District Health Board Charitable Trust; Neurological Foundation of New Zealand. Publisher Copyright: {\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.",

year = "2018",

month = jul,

day = "1",

doi = "10.1136/bmjopen-2018-021521",

language = "English",

volume = "8",

journal = "BMJ Open",

issn = "2044-6055",

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Mrkobrada, M, Chan, MTV, Cowan, D, Spence, J, Campbell, D, Wang, CY, Torres, D, Malaga, G, Sanders, RD, Brown, C, Sigamani, A, Szczeklik, W, Dmytriw, AA, Agid, R, Smith, EE, Hill, MD, Sharma, M, Sharma, M, Tsai, S, Mensinkai, A, Sahlas, DJ, Guyatt, G, Pettit, S, Copland, I, Wu, WKK, Yu, SCH, Gin, T, Loh, PS, Ramli, N, Siow, YL, Short, TG, Waymouth, E, Kumar, J, Dasgupta, M, Murkin, JM, Fuentes, M, Ortiz-Soriano, V, Lindroth, H, Simpson, S, Sessler, D & Devereaux, PJ 2018, 'Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study', BMJ Open, vol. 8, no. 7, e021521. https://doi.org/10.1136/bmjopen-2018-021521

Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study. / Mrkobrada, Marko; Chan, Matthew T.V.; Cowan, David et al.
In: BMJ Open, Vol. 8, No. 7, e021521, 01.07.2018.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study

T2 - A prospective international cohort study

AU - Mrkobrada, Marko

AU - Chan, Matthew T.V.

AU - Cowan, David

AU - Spence, Jessica

AU - Campbell, Douglas

AU - Wang, Chew Yin

AU - Torres, David

AU - Malaga, German

AU - Sanders, Robert D.

AU - Brown, Carl

AU - Sigamani, Alben

AU - Szczeklik, Wojciech

AU - Dmytriw, Adam Andrew

AU - Agid, Ronit

AU - Smith, Eric E.

AU - Hill, Michael D.

AU - Sharma, Manas

AU - Sharma, Mukul

AU - Tsai, Scott

AU - Mensinkai, Arun

AU - Sahlas, Demetrios J.

AU - Guyatt, Gordon

AU - Pettit, Shirley

AU - Copland, Ingrid

AU - Wu, William K.K.

AU - Yu, Simon C.H.

AU - Gin, Tony

AU - Loh, Pui San

AU - Ramli, Norlisah

AU - Siow, Yee Lein

AU - Short, Timothy G.

AU - Waymouth, Ellen

AU - Kumar, Jonathan

AU - Dasgupta, Monidipa

AU - Murkin, John M.

AU - Fuentes, Maite

AU - Ortiz-Soriano, Victor

AU - Lindroth, Heidi

AU - Simpson, Sara

AU - Sessler, Daniel

AU - Devereaux, P. J.

N1 - Funding Information: Competing interests EES reports grants from McMaster University, during the conduct of the study. TG reports grants from Food and Health Bureau, HK government, during the conduct of the study. PJD reports grants from Abbott Diagnostics, grants from Boehringer-Ingelheim, grants from Covidien, grants from Octopharma, grants from Phillips Healthcare, grants from Roche Diagnostics, grants from Stryker, outside the submitted work. DoC reports grants from Neurological Foundation of New Zealand, during the conduct of the study. MDH reports personal fees from Merck, non-financial support from Hoffmann-La Roche Canada, grants from Covidien (Medtronic), grants from Boehringer-Ingleheim, grants from Stryke, grants from Medtronic, outside the submitted work. In addition, MDH has a patent Systems and Methods for Assisting in Decision-Making and Triaging for Acute Stroke Patients pending to US Patent office Number: 62/086,077 and owns stock in Calgary Scientific, a company that focuses on medical imaging software, is a director of the Canadian Federation of Neurological Sciences, a not-for-profit group and has received grant support from Alberta Innovates Health Solutions, CIHR, Heart and Stroke Foundation of Canada, National Institutes of Neurological Disorders and Stroke. MTVC reports grants from Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong government during the conduct of the study. TGS reports grants from New Zealand Neurological Foundation during the conduct of the study. Funding Information: funding This work was supported by CIHR’s Strategy for Patient-Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care; Health and Medical Research Fund (11120321), Food and Health Bureau, Hong Kong Government; Auckland District Health Board Charitable Trust; Neurological Foundation of New Zealand. Publisher Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - adult anaesthesia

KW - adult surgery

KW - stroke medicine

UR - http://www.scopus.com/inward/record.url?scp=85049941571&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2018-021521

DO - 10.1136/bmjopen-2018-021521

M3 - Article

C2 - 29982215

AN - SCOPUS:85049941571

SN - 2044-6055

VL - 8

JO - BMJ Open

JF - BMJ Open

IS - 7

M1 - e021521

ER -

Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: A prospective international cohort study

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