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

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 and Su-Shun Lo
Additional contact information
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
Li-Fu Chen: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
Jau-Ching Wu: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Yu-Chun Chen: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Wen-Cheng Huang: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Laura Liu: Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Henrich Cheng: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Su-Shun Lo: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan

IJERPH, 2015, vol. 12, issue 10, 1-10

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.

Keywords: adult spinal deformity (ASD); spinal fusion surgery; stroke; National Health Insurance Research Database (NHIRD) (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2015
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/12/10/12618/pdf (application/pdf)
https://www.mdpi.com/1660-4601/12/10/12618/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:12:y:2015:i:10:p:12618-12627:d:56967

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().