Intraoperative ischemic stroke in elective spine surgery : a retrospective study of incidence and risk / Basem Ishak, MD, Amir Abdul-Jabbar, MD, Amit Singla, MD, Emre Yilmaz, MD, Alexander von Glinski, MD, Wyatt L. Ramey, MD, Ronen Blecher, MD, Zane Tymchak, MD, Rod Oskouian, MD, and Jens R. Chapman, MD

Study design: Retrospective study. - Objective: To determine incidence, risk factors, complications, and early postoperative outcome in patients with intraoperative ischemic stroke during elective spine surgery. - Summary of backgraund data: Overall, stroke is the fifth leading cause of death in the United States and the second leading cause of death worldwide. It can be a catastrophic event and the main cause of neurological disability in adults. - Methods: A retrospective review of the electronic medical records of patients who underwent elective spine surgery between January 2016 and November 2018 at a larger tertiary referral center was conducted. Patients with infection and neoplastic disease were excluded. Patient demographics, pre- and postoperative neurological status, surgical treatment, surgical time, blood loss, intraoperative abnormalities, risk factors, history of stroke, medical treatment, diagnostics, hospital stay, complications, and mortality were collected. - Results: Out of 5029 surgically treated patients receiving elective spine surgery, a total of seven patients (0.15%) were identified who developed an ischemic stroke during the surgical procedure. Patients were predominantly females (n=6). Ischemic pontine stroke occurred in two patients. Further distributions of ischemic stroke were: left caudate nucleus, left posterior inferior cerebellar artery, left external capsule, left middle cerebral artery, and acute ischemic supratentorial spots. The main risk factors identified for intraoperative ischemic stroke include hypertension, diabetes, smoking, dyslipidemia, and possibly major intraoperative CSF leak. Three patients (43%) had neurological deficits which did not improve during hospital stay. Two patients recovered fully and two patients died. Therefore, in-hospital mortality rate of this subset of patients was 29%. - Conclusion: With the increase of spinal procedures, it is important to identify patients at risk for having an ischemic stroke and to optimize their comorbidities preoperatively. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization. - LEVEL OF EVIDENCE: 4..

Medienart:

E-Artikel

Erscheinungsjahr:

January 15, 2020

2020

Erschienen:

January 15, 2020

Enthalten in:

Zur Gesamtaufnahme - volume:45

Enthalten in:

Spine - 45(2020), 2, Seite 109-115

Sprache:

Englisch

Beteiligte Personen:

Ishak, Basem, 1984- [VerfasserIn]
Abdul-Jabbar, Amir [VerfasserIn]
Singla, Amit [VerfasserIn]
Yilmaz, Emre, 1981- [VerfasserIn]
Glinski, Alexander von, 1988- [VerfasserIn]
Ramey, Wyatt L. [VerfasserIn]
Blecher, Ronen [VerfasserIn]
Tymchak, Zane [VerfasserIn]
Oskouian, Rod J. [VerfasserIn]
Chapman, Jens R. [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

Themen:

Aged
Aged, 80 and over
Brain Ischemia
Cerebrospinal Fluid Leak
Comorbidity
Diabetes Mellitus
Dyslipidemias
Elective Surgical Procedures
Female
Hospital Mortality
Humans
Hypertension
Incidence
Intraoperative Complications
Male
Middle Aged
Retrospective Studies
Risk Factors
Smoking
Spine
Stroke

Anmerkungen:

Gesehen am 06.08.2020

Umfang:

7

doi:

10.1097/BRS.0000000000003184

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

1726575438

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