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Huang LC, Chung WF, Liu SW, Chang PY, Chen LF, Wu JC, Chen YC, Huang WC, Liu L, Cheng H, Lo SS. 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; 12:12618-27. [PMID: 26473897 PMCID: PMC4626989 DOI: 10.3390/ijerph121012618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- 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.
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