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Myocardial Infarction After Lumbar Surgery: A Critical Meta-Analysis of Cohort versus Database Studies for a Rare
Roberto J Perez-Roman1, Victor M Lu1, Vaidya Govindarajan1
1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Background:
One potentially fatal complication of spine surgery is myocardial infarction (MI). There is still uncertainty of the true incidence of MI within subsets of spine surgeries. The aim of this study was to survey the contemporary spine literature and ascertain the true incidence of MI after lumbar spine surgery, as well as to provide commentary on the inherent assumptions made when interpreting cohort versus database studies on this topic.
Methods:
A systematic search of 4 electronic databases from inception to November 2020 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. MI incidence was then estimated by random-effects meta-analyses of proportions based on cohort versus database studies.
Results:
A total of 34 cohort studies and 32 database studies describing 767,326 lumbar procedures satisfied all criteria for selection. There were 12,170 (2%) cases from cohort studies and 755,156 (98%) cases from database studies. Cohort studies reported a significantly older patient cohort (P < 0.01) and longer follow-up period than did database studies (P < 0.03). Using cohort studies only, the incidence of MI was 0.44% (P heterogeneity < 0.01), whereas using database studies only, the incidence of MI was 0.41% (P heterogeneity < 0.01). These 2 incidences were statistically different (P interaction = 0.01). Bias analysis indicated that cohort studies were more vulnerable to small-study biases than were database studies.
Conclusions:
Although infrequent, the incidence of MI after lumbar spine surgery is unequivocally nonzero. Furthermore, the literature on this topic remains skewed based on study type, and translation of academic findings into practice should be wary of this.
Insights
Myocardial infarction (MI) after lumbar spine surgery is a rare but serious complication. This study found the incidence of MI to be 0.44% in cohort studies and 0.41% in database studies, highlighting potential biases in literature interpretation.
Area of Science:
- Neurosurgery
- Cardiology
- Medical Informatics
Background:
- Myocardial infarction (MI) is a potentially fatal complication following spine surgery.
- The precise incidence of MI in specific spine surgery subsets remains unclear.
- This study addresses the uncertainty surrounding MI incidence after lumbar spine surgery.
Purpose of the Study:
- To systematically review the spine literature and determine the incidence of MI after lumbar spine surgery.
- To analyze assumptions in interpreting cohort versus database studies on this topic.
- To provide commentary on the implications of study design on reported MI incidence.
Main Methods:
- A systematic literature search was performed across four electronic databases (inception to November 2020) adhering to PRISMA guidelines.
- Articles were screened using predefined criteria.
- Random-effects meta-analyses of proportions were conducted to estimate MI incidence from cohort and database studies.
Main Results:
- The analysis included 34 cohort and 32 database studies, encompassing 767,326 lumbar procedures.
- Cohort studies reported a higher MI incidence (0.44%) compared to database studies (0.41%), with a statistically significant difference (P interaction = 0.01).
- Cohort studies featured older patients and longer follow-up periods, but were more susceptible to small-study biases.
Conclusions:
- Myocardial infarction after lumbar spine surgery, while infrequent, is a confirmed risk.
- The existing literature on MI incidence is influenced by study type, necessitating caution when translating findings into clinical practice.
- Discrepancies between cohort and database study findings underscore the importance of methodological considerations in risk assessment.
