Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study
AbstractObjectives: 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
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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.
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. International Journal of Environmental Research and Public Health. 2015; 12(10):12618-12627.Chicago/Turabian Style
Huang, Liang-Chung; Chung, Wu-Fu; Liu, Shih-Wei; Chang, Peng-Yuan; Chen, Li-Fu; Wu, Jau-Ching; Chen, Yu-Chun; Huang, Wen-Cheng; Liu, Laura; Cheng, Henrich; Lo, Su-Shun. 2015. "Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study." Int. J. Environ. Res. Public Health 12, no. 10: 12618-12627.