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

Author

Listed:
  • Liang-Chung Huang

    (Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan)

  • Wu-Fu Chung

    (Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan)

  • Shih-Wei Liu

    (Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan)

  • Peng-Yuan Chang

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
    Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan)

  • Li-Fu Chen

    (Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
    School of Medicine, National Yang-Ming University, Taipei 112, Taiwan)

  • Jau-Ching Wu

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
    Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan)

  • Yu-Chun Chen

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
    Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan
    Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 260, Taiwan)

  • Wen-Cheng Huang

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
    Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan)

  • Laura Liu

    (Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
    College of Medicine, Chang Gung University, Taoyuan 333, Taiwan)

  • Henrich Cheng

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
    Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan
    Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan)

  • Su-Shun Lo

    (School of Medicine, National Yang-Ming University, Taipei 112, Taiwan)

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.

Suggested Citation

  • Liang-Chung Huang & Wu-Fu Chung & Shih-Wei Liu & Peng-Yuan Chang & Li-Fu Chen & Jau-Ching Wu & Yu-Chun Chen & Wen-Cheng Huang & Laura Liu & Henrich Cheng & Su-Shun Lo, 2015. "Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study," IJERPH, MDPI, vol. 12(10), pages 1-10, October.
    • Handle: RePEc:gam:jijerp:v:12:y:2015:i:10:p:12618-12627:d:56967
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    References listed on IDEAS

    as
    1. Ching-Lan Wu & Jau-Ching Wu & Wen-Cheng Huang & Hung-Ta H Wu & Hong-Jen Chiou & Laura Liu & Yu-Chun Chen & Tzeng-Ji Chen & Henrich Cheng & Cheng-Yen Chang, 2012. "The Risk of Stroke after Percutaneous Vertebroplasty for Osteoporosis: A Population-Based Cohort Study," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-9, January.
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