Perioperative stroke in patients undergoing spinal surgery: a retrospective cohort study

Abstract

Background 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. Method 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. Result 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. Conclusion 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.

Hypoglossal nerve palsy following spine surgery in Klippel-Feil syndrome patient

“…Although rare, perioperative strokes have been reported in patients receiving spine surgery. A recent study of 17,408 individuals undergoing spine surgery reported an incidence rate of 0.07% for this complication 23. Perioperative strokes occur more frequently during cardiac related operations wherein manipulation of the great vessels can result in dislodgement of particulates which occlude small arteries within the brain, resulting in a stroke 24…”

“…A recent study of 17,408 individuals undergoing spine surgery reported an incidence rate of 0.07% for this complication. 23 Perioperative strokes occur more frequently during cardiac related operations wherein manipulation of the great vessels can result in dislodgement of particulates which occlude small arteries within the brain, resulting in a stroke. 24 We believe that a potential anatomical variation of the hypoglossal nerve related to Patient Z's KFS may have contributed to nerve compression from the endotracheal tube and caused the hypoglossal nerve palsy.…”

Association of Hyperlipidemia With Perioperative Complications in Posterior Cervical Spine Fusion

“…Although there are limited reports on the association between HLD and the occurrence of MI after cervical fusion, a higher incidence of cardiac events was reported for PCF compared with ACDF and posterior cervical decompression 36 . Several studies showed that HLD was associated with the occurrence of cerebrovascular accidents after spinal surgery 37,38 . The incidence of these conditions is often multifactorial, including comorbidities, anesthetic complications, and intraoperative events and the presence of HTN secondary to HLD is also recognized as a risk for the occurrence of perioperative cardiovascular and cerebrovascular events 39 .…”

“…36 Several studies showed that HLD was associated with the occurrence of cerebrovascular accidents after spinal surgery. 37,38 The incidence of these conditions is often multifactorial, including comorbidities, anesthetic complications, and intraoperative events and the presence of HTN secondary to HLD is also recognized as a risk for the occurrence of perioperative cardiovascular and cerebrovascular events. 39 Therefore, further studies are needed to validate the impact of HLD.…”

Perioperative Cerebrovascular Accidents in Spine Surgery: A Retrospective Descriptive Study and A Systematic Review with Meta-Analysis

“…The Newcastle-Ottawa Scale scores for the included studies ranged from 6 to 7. Notably, the CVAs in our study included other types besides stroke (e.g., PRES), setting our study apart from the research conducted by Ohya et al 2 and Yan et al 17…”