Post-Stroke Elective Surgery Timing — FRCA Final MCQ

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ModeratePreoperative AssessmentPost-Stroke Elective Surgery TimingFRCA Final

A 65-year-old man (ASA III) with a history of ischaemic stroke 3 months ago is listed for elective inguinal hernia repair. According to current guidelines, what is the minimum recommended interval between an ischaemic stroke and elective non-cardiac surgery?

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Correct answer: D — 6 months

Current guidelines recommend deferring elective non-cardiac surgery for at least 3-6 months (ideally 9 months) after an ischaemic stroke. The risk of perioperative recurrent stroke is highest in the first 3 months (approximately 5-8%) and decreases progressively. By 9 months, the risk approaches baseline. If surgery is more urgent, individual risk-benefit assessment is required. Perioperative blood pressure should be carefully managed (avoid hypotension), antiplatelet therapy continued, and dehydration avoided.

Reference: ESC/ESA – 2022 – Non-cardiac surgery cardiovascular guidelines; NICE – 2019 – NG128 Stroke and TIA