Department of Neurology, Beijing Jishuitan Hospital, Beijing, China.
BMC Musculoskelet Disord. 2022 Jul 8;23(1):652. doi: 10.1186/s12891-022-05591-4.
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.
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.
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.
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.
在中国人群中，脊柱手术后围手术期卒中（包括缺血性卒中和出血性卒中）的发生率尚未得到充分研究。特定的脊柱或急诊/择期手术是否与围手术期卒中相关仍存在争议。本研究旨在调查围手术期卒中的发生率、健康经济学负担、临床结局和相关危险因素。
本研究采用回顾性队列研究，使用电子医院信息系统数据库，纳入 2015 年 1 月 1 日至 2021 年 1 月 1 日在中国一家三级医院接受脊柱手术的患者。患者年龄≥18 岁。我们记录了患者的人口统计学、合并症和健康经济学数据。临床结局包括住院期间围手术期卒中及相关危险因素。记录了患者的手术数据、麻醉数据和临床表现。
本研究共纳入 17408 例接受脊柱手术的患者。12 例患者发生围手术期卒中，其中缺血性卒中 7 例（58.3%），出血性卒中 5 例（41.7%）。围手术期卒中发生率为 0.07%（12/17408）。总共 12 例卒中患者接受了脊柱融合术。围手术期卒中患者的住院时间较长（38.33 天 vs. 9.78 天，p<0.001），住院费用较高（人民币 175642 元 vs. 人民币 81114 元，p<0.001）。出院时，50%的围手术期患者有严重结局。围手术期卒中的平均发病时间为术后 1.3 天。卒中病史（OR 146.046，95%CI：28.102-759.006，p<0.001）和高脂血症（OR 4.490，95%CI：1.182-17.060，p=0.027）与围手术期卒中相关。
在中国一家三级医院，脊柱手术围手术期卒中的发生率为 0.07%，其中出血性卒中比例较高。围手术期卒中患者经济负担沉重，结局严重。既往卒中病史和高脂血症与围手术期卒中相关。
