The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

BMC Musculoskelet Disord

et al. 2020

Background Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups. Methods A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation. Results A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history. Conclusions The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.

Section: Implications and Relevancementioning

confidence: 86%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

BMC Musculoskelet Disord

et al. 2020

“…Lad et al reached similar conclusions and stated that African American patients were more likely to experience postoperative complications of any kind for lumbar stenosis, even after adjusting for length of hospital stay, comorbidities, sex, and age [27]. Despite controversies surrounding appropriate peri-operative management of complicated medication regimens among elderly patients, healthcare providers should ensure that modi able stroke risks are controlled and should include any concerns in discussions with their patients [28]. With regard to undiagnosed diabetes, a 2017 review by Epstein recommended routine pre-operative screening for diabetes with HbA1c levels among spinal surgery patients to facilitate pre-operative, intra-operative, and post-operative management [29].…”

Section: Implications and Relevancementioning

confidence: 86%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

et al. 2020

Preprint

Background: Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups.Methods: A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥ 183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operationResults: A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38%, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52%, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68%, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history.Conclusions: The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.

“…Despite controversies surrounding appropriate peri-operative management of complicated medication regimens among elderly patients, healthcare providers should ensure that modi able stroke risks are controlled and should include any concerns in discussions with their patients [28]. With regard to undiagnosed diabetes, a 2017 review by Epstein recommended routine pre-operative screening for diabetes with HbA1c levels among spinal surgery patients to facilitate pre-operative, intra-operative, and post-operative management [29].…”

Section: Implications and Relevancementioning

confidence: 99%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

et al. 2020

Preprint

Background: Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups. Methods: A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥ 183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation Results: A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38%, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52%, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68%, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history. Conclusions: The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.