Background: Post-operative atrial fibrillation (POAF) is a frequent occurrence after non-cardiac surgery due to its relatively short duration, the risk of stroke is unclear. Therefore, we performed a meta-analysis of randomized controlled studies and observational studies. 
Methods: Electronic databases were searched from inception to December 2016, for all studies that reported strokes in patients who developed POAF following non-cardiac surgery. We used random-effects models to summarize the studies. Two reviewers independently performed the literature search and a random-effects model was used to summarize the studies. 
Results: We retained 15 studies enrolling 1,694,663 patients for the final analyses including 16,061 patients who had POAF and 1,678,602 patients with no POAF. There were four randomized controlled studies, three prospective and eight retrospective cohort studies.
At one-month follow-up, POAF was associated with almost three times increased risk of  stroke [odds ratio (OR): 2.84 (95% Confidence interval (CI): 2.18-3.70); n=8 studies]. In 7 studies with >12 months follow up, POAF was associated with nearly four times increase in risk of stroke with OR: 3.92 (95% CI: 3.42-4.50). The risk of stroke was increased after both thoracic (OR: 2.83; 95% CI: 2.08-3.85; p≤0.001) and non-thoracic (OR: 3.64; 95% CI: 3.01-4.41; p≤0.001) surgeries.
Conclusions: POAF was associated with increased short and long-term risk of stroke after non-cardiac surgery.  Future studies are needed to evaluate the impact of anticoagulation in decreasing the risk of stroke in these patients.

Stroke Associated with Post-operative Atrial Fibrillation after Non-Cardiac Surgery: A Meta-Analysis