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Morimoto T, Kobayashi T, Hirata H, Tsukamoto M, Yoshihara T, Toda Y, Ito H, Otani K, Mawatari M. Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis. Spine Surg Relat Res 2024; 8:171-179. [PMID: 38618211 PMCID: PMC11007245 DOI: 10.22603/ssrr.2023-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Perioperative cerebrovascular accidents (CVAs) related to spine surgery, although rare, can lead to significant disabilities. More studies on spine surgeries are required to identify those at risk of perioperative CVAs. The characteristics and outcomes of patients that experienced CVAs during spine surgery were assessed through a retrospective descriptive study and meta-analysis. Methods Patients aged ≥18 years who underwent spine surgery under general anesthesia at a hospital between April 2011 and March 2023 were examined. Of the 2,391 initially identified patients, 2,346 were included after excluding 45 who underwent debridement for surgical site infections. Subsequently, a meta-analysis including the present retrospective descriptive study was conducted. Databases such as PubMed and Google Scholar were searched for original peer-reviewed articles written in English. Results Of the 2,346 patients, 4 (0.17%) (three men, one woman) exhibited perioperative CVAs associated with spine surgery. The CVAs were diverse in nature: one case of cerebral hemorrhage resulting from dural injury during posterior occipitocervical fusion, two cases of cerebral infarctions after lumbar laminectomy and anterior thoracic fusion due to anticoagulant discontinuation, and one case of posterior reversible encephalopathy syndrome following microscopic lumbar discectomy due to gestational hypertension. The subsequent meta-analysis included three studies (n=186,860). It showed several risk factors for perioperative CVAs, including cervical level (pooled odds ratio [OR]=1.33), hypertension (pooled OR=2.27), atrial fibrillation (pooled OR=8.78), history of heart disease (pooled OR=2.47), and diabetes (pooled OR=2.13). Conclusions It was speculated that the potential risk factors for the four perioperative CVA cases of spine surgery in this retrospective descriptive study were intraoperative dural injury, preoperative anticoagulant discontinuation, and gestational hypertension history. The meta-analysis revealed that cervical spine surgery, hypertension, atrial fibrillation, heart disease, and diabetes increased the CVA risk. This highlights the need for risk assessment, preoperative optimization, and postoperative care to reduce spine surgery-associated perioperative CVAs.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hayato Ito
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Yan X, Yan LR, Ma ZG, Jiang M, Gao Y, Pang Y, Wang WW, Qin ZH, Han YT, You XF, Ruan W, Wang Q. Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery. World J Clin Cases 2023; 11:5430-5439. [PMID: 37637679 PMCID: PMC10450377 DOI: 10.12998/wjcc.v11.i23.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication. AIM To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery. METHODS A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded. RESULTS A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019). CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Li-Rong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhi-Gang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang Gao
- Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei-Wei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Zhao-Hui Qin
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Yang-Tong Han
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Xiao-Fan You
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Wei Ruan
- Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
| | - Qian Wang
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
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Yan X, Pang Y, Yan L, Ma Z, Jiang M, Wang W, Chen J, Han Y, Guo X, Hu H. Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:652. [PMID: 35804343 PMCID: PMC9264537 DOI: 10.1186/s12891-022-05591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of perioperative stroke following spinal surgery, including ischemic and hemorrhagic stroke, has not been fully investigated in the Chinese population. Whether specific spinal or emergency/elective procedures are associated with perioperative stroke remains controversial. This study aimed to investigate the incidence of perioperative stroke, health economic burden, clinical outcomes, and associated risk factors. METHOD A retrospective cohort study using an electronic hospital information system database was conducted from Jan 1, 2015, to Jan 1, 2021, in a tertiary hospital in China. Patients aged ≥18 years who had undergone spinal surgery were included in the study. We recorded patient demographics, comorbidities, and health economics data. Clinical outcomes included perioperative stroke during hospitalization and associated risk factors. The patients' operative data, anesthetic data, and clinical manifestations were recorded. RESULT A total of 17,408 patients who had undergone spinal surgery were included in this study. Twelve patients had perioperative stroke, including seven ischemic stroke (58.3%) and five hemorrhagic stroke (41.7%). The incidence of perioperative stroke was 0.07% (12/17,408). In total, 12 stroke patients underwent spinal fusion. Patients with perioperative stroke were associated with longer hospital stay (38.33 days vs. 9.78 days, p < 0.001) and higher hospital expenses (RMB 175,642 vs. RMB 81,114, p < 0.001). On discharge, 50% of perioperative patients had severe outcomes. The average onset time of perioperative stroke was 1.3 days after surgery. Stroke history (OR 146.046, 95% CI: 28.102-759.006, p < 0.001) and hyperlipidemia (OR 4.490, 95% CI: 1.182-17.060, p = 0.027) were associated with perioperative stroke. CONCLUSION The incidence of perioperative stroke of spinal surgery in a tertiary hospital in China was 0.07%, with a high proportion of hemorrhagic stroke. Perioperative stroke patients experienced a heavy financial burden and severe outcomes. A previous stroke history and hyperlipidemia were associated with perioperative stroke.
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Affiliation(s)
- Xin Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China.
| | - Ying Pang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Lirong Yan
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhigang Ma
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Jiang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Weiwei Wang
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Chen
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangtong Han
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaolei Guo
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongtao Hu
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
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Arena PJ, Mo J, Sabharwal C, Begier E, Zhou X, Gurtman A, Liu Q, Shen R, Wentworth C, Huang K. The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:612. [PMID: 32928165 PMCID: PMC7488711 DOI: 10.1186/s12891-020-03631-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/03/2020] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- Patrick J Arena
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA.
| | - Jingping Mo
- Safety Surveillance Research, Pfizer Inc, New York, NY, USA
| | - Charu Sabharwal
- Vaccine Research & Development, Pfizer Inc, Pearl River, NY, USA
| | - Elizabeth Begier
- Vaccine Research & Development, Pfizer Inc, Pearl River, NY, USA
| | - Xiaofeng Zhou
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | | | - Qing Liu
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, Collegeville, PA, USA
| | - Rongjun Shen
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | - Charles Wentworth
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
| | - Kui Huang
- Global Medical Epidemiology & Big Data Analysis, Pfizer Inc, New York, NY, USA
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