Institute of Pharmacology, National Yang-Ming University, 2F, No. 322, Shih-Pai Rd, Sec. 2, Peitou, Taipei 11217, Taiwan.
Spine J. 2012 Jun;12(6):492-9. doi: 10.1016/j.spinee.2012.05.008. Epub 2012 Jun 15.
Postoperative stroke is a rare complication of spinal fusion surgery, but its relevant risk and incidence remain unclear.
To investigate the incidence and risk of stroke after spinal fusion surgery.
Cohort study.
All study subjects were extracted from a nationwide representative cohort of one million people from 2000 to 2005.
Stroke, including hemorrhagic and ischemic, during the study period.
An exposure group of 2,249 subjects who received spinal fusion surgery during the study period was compared with 2,203 control subjects matched by age, sex, and propensity score. All were followed up for 3 years for all kinds of stroke. Demographics, comorbidities, and nonmeasurable covariates were matched between the two groups. Kaplan-Meier analyses were performed, with adjustments by Cox regression model.
There were 4,452 subjects, including 2,249 spinal fusion patients and 2,203 controls, who were followed up for 12,967 person-years. The incidence rates of any, hemorrhagic, and ischemic strokes were 9.95, 1.21, and 8.86, respectively, per 1,000 person-years in the spinal fusion group and 11.5, 1.69, and 9.93, respectively, in the comparison group. Patients who received spinal fusion surgery were less likely to have any stroke (crude hazard ratio [HR]=0.87, p=.393), hemorrhagic stroke (HR=0.72, p=.473), and ischemic stroke (HR=0.89, p=.582) than the comparison group but without statistical significance. After adjusting for demographics, comorbidities, and medications, there were still no significant differences for risks of any, hemorrhagic, and ischemic strokes (adjusted HR=0.89, 1.36, and 0.87; p=.522, .553, and .477, respectively) in the spinal fusion group.
Patients receiving spinal fusion surgery have similar incidence rates of having a stroke within 3 years postoperation as those without surgery. Risks of any postoperative stroke are similar or insignificantly lower in the spinal fusion group.
术后中风是脊柱融合手术后罕见的并发症，但相关风险和发病率尚不清楚。
研究脊柱融合手术后中风的发病率和风险。
队列研究。
所有研究对象均来自 2000 年至 2005 年全国范围内的 100 万人代表性队列。
研究期间的中风，包括出血性和缺血性中风。
对研究期间接受脊柱融合手术的 2249 名患者进行了暴露组分析，并与年龄、性别和倾向评分匹配的 2203 名对照组进行了比较。所有患者均随访 3 年，观察各种中风的发生情况。两组患者的人口统计学、合并症和不可测量的混杂因素进行了匹配。采用 Kaplan-Meier 分析，并用 Cox 回归模型进行调整。
共有 4452 名患者，包括 2249 名脊柱融合患者和 2203 名对照组，随访 12967 人年。脊柱融合组任何、出血性和缺血性中风的发生率分别为每 1000 人年 9.95、1.21 和 8.86，对照组分别为 11.5、1.69 和 9.93。与对照组相比，接受脊柱融合手术的患者发生任何类型中风（粗风险比[HR]=0.87，p=.393）、出血性中风（HR=0.72，p=.473）和缺血性中风（HR=0.89，p=.582）的可能性较低，但无统计学意义。在调整人口统计学、合并症和药物治疗后，脊柱融合组患者发生任何、出血性和缺血性中风的风险仍无显著差异（调整 HR=0.89、1.36 和 0.87；p=.522、.553 和.477）。
术后 3 年内接受脊柱融合手术的患者中风发生率与未手术患者相似。脊柱融合组任何术后中风的风险相似或显著较低。
