Abstract
Background: Although stroke is an uncommon but life-threatening 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 adults undergoing elective posterior lumbar fusion (PLF) during 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. Incidence proportions (IPs) and rates (IRs) of stroke were 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 IP of stroke following elective PLF ranged from 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization to 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation; the IR of stroke following elective PLF per 1000 person-years decreased consistently from 229.08 (95% CI: 192.38, 272.78) during index hospitalization to 13.68 (95% CI: 12.51, 14.96) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences than white, Asian, or other patients. Furthermore, the incidence of post-operative stroke was higher among patients with a history of type 2 diabetes than among patients without such history. Conclusions: The incidence of stroke following elective PLF found here using an EHR database is slightly higher than that reported in the literature; however, the discrepancy is due to differences in the variable definitions, study populations, follow-up periods, and data sources between our study and those in the literature.
Survival Status and Predictors of Loss to Follow-up Among Adult Patients with Tuberculosis on Follow-up and Care in Public Health Facilities of Sheka Zone, South-West Ethiopia: Facility-Based, Retrospective Cohort Study
