The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

Abstract

Background Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups. Methods A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation. Results A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history. Conclusions The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.

Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study

“…The published literature has demonstrated that age, renal disease, atrial fibrillation, history of stroke, cardiac valvular disease, etc., are risk factors for perioperative stroke, but has offered little insight regarding the risk factors unique to spinal surgery [2,6,26]. Our study found that a previous stroke history was a significant risk factor (OR = 146.046) for perioperative stroke in both elective and emergency spinal surgery.…”

“…In some spinal surgery, the incidence is much higher. An American retrospective study of 43,063 patients with elective posterior lumbar fusion demonstrated an incidence of 0.29% [6]. In a Japanese emergency cervical spinal injury study of 11,005 patients, the incidence of ischemic stroke was as high as 1.0% [10].…”

“…The incidence of perioperative stroke of spinal surgery varies widely from 0.006 to 1.0% in different studies, depending on selected surgical procedures and patient populations [4][5][6][7][8][9][10]. Most studies have focused on ischemia rather than hemorrhagic stroke and have concentrated on specific spinal operations, such as lumbar or cervical spinal fusion.…”

“…There are studies on the risk factors of perioperative stroke in spinal surgery, such as advanced age and diabetes [6], but whether specific spinal procedures or emergency/elective procedures are risk factors for perioperative stroke is controversial [11]. It is necessary to identify the risk factors for perioperative stroke in spinal surgery to prevent complications.…”

The incidence of acute myocardial infarction after elective spinal fusions or joint replacement surgery in the United States: a large-scale retrospective observational cohort study in 322,585 patients

“…It is important to have background epidemiology data about post-operative AMI during various risk windows and among different sub-groups to contextualize safety data in clinical trials and the general population. This cohort study built on previous research [ 10 ], and it was designed to estimate the incidence of AMI among adults undergoing elective SF, THA, or TKA using a large electronic healthcare record (EHR) database in the US. The objectives of this study were to estimate the incidence of AMI among adults undergoing elective SF, THA, or TKA in different post-operative periods and to characterize high-risk sub-populations in the US.…”