Next Article in Journal
Hepatic and Nephric NRF2 Pathway Up-Regulation, an Early Antioxidant Response, in Acute Arsenic-Exposed Mice
Previous Article in Journal
Prevalence and Molecular Characteristics of Waterborne Pathogen Legionella in Industrial Cooling Tower Environments
Article Menu

Export Article

Open AccessArticle
Int. J. Environ. Res. Public Health 2015, 12(10), 12618-12627; doi:10.3390/ijerph121012618

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

1
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
3
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan
4
Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan
5
Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 260, Taiwan
6
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
7
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
8
Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan
*
Authors to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 14 August 2015 / Revised: 28 September 2015 / Accepted: 30 September 2015 / Published: 12 October 2015
View Full-Text   |   Download PDF [766 KB, uploaded 12 October 2015]   |  

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. View Full-Text
Keywords: adult spinal deformity (ASD), spinal fusion surgery, stroke, National Health Insurance Research Database (NHIRD) adult spinal deformity (ASD), spinal fusion surgery, stroke, National Health Insurance Research Database (NHIRD)
Figures

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Scifeed alert for new publications

Never miss any articles matching your research from any publisher
  • Get alerts for new papers matching your research
  • Find out the new papers from selected authors
  • Updated daily for 49'000+ journals and 6000+ publishers
  • Define your Scifeed now

SciFeed Share & Cite This Article

MDPI and ACS Style

Huang, L.-C.; Chung, W.-F.; Liu, S.-W.; Chang, P.-Y.; Chen, L.-F.; Wu, J.-C.; Chen, Y.-C.; Huang, W.-C.; Liu, L.; Cheng, H.; Lo, S.-S. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study. Int. J. Environ. Res. Public Health 2015, 12, 12618-12627.

Show more citation formats Show less citations formats

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top