Cerebral vascular accidents after lumbar spine fusion

Alejandro Marquez-Lara, Sreeharsha V Nandyala, Steven J Fineberg, Kern Singh
Spine 2014 April 15, 39 (8): 673-7

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.


Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"