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

International Journal of Environmental Research and Public Health

Liang-Chung Huang¹  Wu-Fu Chung¹  Shih-Wei Liu¹  Peng-Yuan Chang²  Li-Fu Chen¹  Jau-Ching Wu²  Yu-Chun Chen²  Wen-Cheng Huang²  Laura Liu³  Henrich Cheng²  Su-Shun Lo² 

[1] Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan; E-Mails:;School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; E-Mails:;Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; E-Mail:

关键词: adult spinal deformity (ASD);    spinal fusion surgery;    stroke;    National Health Insurance Research Database (NHIRD);   

DOI  :  10.3390/ijerph121012618

来源: mdpi

【 摘 要 】

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.

【 授权许可】

CC BY   
© 2015 by the authors; licensee MDPI, Basel, Switzerland.