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Cerebral Vascular Accidents After Lumbar Spine Fusion

Marquez-Lara, Alejandro MD; Nandyala, Sreeharsha V. BA; Fineberg, Steven J. MD; Singh, Kern MD

doi: 10.1097/BRS.0000000000000197

Study Design. Retrospective cohort.

Objective. To determine the impact of a cerebral vascular accident (CVA) after lumbar spinal fusion, a population-based database was analyzed to identify the incidence, potential risk factors, hospital resource utilization, and the early postoperative outcomes.

Summary of Background Data. A lumbar fusion (LF) is an effective surgical procedure to treat lumbar degenerative pathology. Although rare, a CVA can be a catastrophic event after an LF.

Methods. The Nationwide Inpatient Sample database was queried from 2002–2011. Patients undergoing an elective anterior lumbar fusion, a posterior lumbar fusion, or a combined anterior-posterior lumbar fusion were separated into subcohorts. Patients with a documented postoperative CVA were identified. Patient demographics, comorbidities (Charlson Comorbidity Index), length of stay, costs, early postoperative outcomes, and mortality were assessed. Statistical analysis involved T tests, χ2 analysis, and binary logistic regression with P < 0.001 denoting significance.

Results. A total of 264,891 LFs were identified between 2002 and 2011 of which 340 (1.3 per 1000) developed a postoperative CVA. Patients with a CVA were significantly older and demonstrated a greater comorbidity burden (Charlson Comorbidity Index). Patients with a CVA incurred a significantly greater length of stay, total hospital costs ($41,454 vs. $25,885), and a greater mortality rate (73.7 vs. 0.8 per 1000 patients). Regression analysis demonstrated that age more than 65 years and a history of neurological disorders, paralysis, congestive heart failure, or electrolyte imbalance were associated with an increased risk of a postoperative CVA.

Conclusion. Patients who developed a postoperative CVA demonstrated a significantly greater incidence of postoperative complications, mortality, and total hospital costs. This study highlights important associated risk factors (e.g., age more than 65, neurological disorders, congestive heart failure) that may enable surgeons to identify high-risk patients prior to surgery. Further studies are warranted to characterize these risk factors and to establish guidelines to mitigate the complications associated with a postoperative CVA.

Level of Evidence: 4

A population-based database was analyzed to determine the incidence of cerebral vascular accidents (CVAs) after lumbar fusion procedures. Patients with a postoperative CVA incurred a longer hospitalization, greater hospital costs, and a higher mortality. Potential risk factors for a postoperative CVA included age more than 65, congestive heart failure, neurological disorders, and electrolyte imbalance.

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612; E-mail:

Acknowledgment date: August 6, 2013. Revision date: November 20, 2013. Acceptance date: December 16, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties.

© 2014 by Lippincott Williams & Wilkins