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Int J Environ Res Public Health. 2015 Oct 12;12(10):12618-27. doi: 10.3390/ijerph121012618.

Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study.

Huang LC1, Chung WF2, Liu SW3, Chang PY4,5, Chen LF6,7, Wu JC8,9, Chen YC10,11,12, Huang WC13,14, Liu L15,16, Cheng H17,18,19, Lo SS20.

Author information

1
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. horus7855@yahoo.com.tw.
2
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. wolfchung2001@yahoo.com.tw.
3
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. shihweiliu123@gmail.com.
4
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. acidbummer@gmail.com.
5
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan. acidbummer@gmail.com.
6
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. 12206@ymuh.ym.edu.tw.
7
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. 12206@ymuh.ym.edu.tw.
8
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. jauching@gmail.com.
9
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan. jauching@gmail.com.
10
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. yuchn.chen@gmail.com.
11
Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan. yuchn.chen@gmail.com.
12
Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 260, Taiwan. yuchn.chen@gmail.com.
13
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. wchuang@vghtpe.gov.tw.
14
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan. wchuang@vghtpe.gov.tw.
15
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan. lauraliu@cgmh.org.tw.
16
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan. lauraliu@cgmh.org.tw.
17
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.
18
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan. hc_cheng@vghtpe.gov.tw.
19
Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.
20
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. sslo@ymuh.ym.edu.tw.

Abstract

OBJECTIVES:

This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke.

METHODS:

Using the National Health Insurance Research Database (NHIRD), a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD) in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439) who received spinal fusion surgery, and the control group (n = 2124) who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups.

RESULTS:

During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years) was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001). Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model).

CONCLUSIONS:

In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke in adult patients with spinal deformity.

KEYWORDS:

adult spinal deformity (ASD), spinal fusion surgery, stroke, National Health Insurance Research Database (NHIRD)

PMID:
26473897
PMCID:
PMC4626989
DOI:
10.3390/ijerph121012618
[Indexed for MEDLINE]
Free PMC Article

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