Background Perioperative ischemic optic neuropathy (ION) causes visual loss in spinal fusion. Previous case–control studies are limited by study size and lack of a random sample. The purpose of this study was to study trends in ION incidence in spinal fusion and risk factors in a large nationwide administrative hospital database. Methods In the Nationwide Inpatient Sample for 1998 to 2012, procedure codes for posterior thoracic, lumbar, or sacral spine fusion and diagnostic codes for ION were identified. ION was studied over five 3-yr periods (1998 to 2000, 2001 to 2003, 2004 to 2006, 2007 to 2009, and 2010 to 2012). National estimates were obtained using trend weights in a statistical survey procedure. Univariate and Poisson logistic regression assessed trends and risk factors. Results The nationally estimated volume of thoracic, lumbar, and sacral spinal fusion from 1998 to 2012 was 2,511,073. ION was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio (IRR) for ION significantly decreased between 1998 and 2012 (IRR, 0.72 per 3 yr; 95% CI, 0.58 to 0.88; P = 0.002). There was no significant change in the incidence of retinal artery occlusion. Factors significantly associated with ION were age (IRR, 1.24 per 10 yr of age; 95% CI, 1.05 to 1.45; P = 0.009), transfusion (IRR, 2.72; 95% CI, 1.38 to 5.37; P = 0.004), and obesity (IRR, 2.49; 95% CI, 1.09 to 5.66; P = 0.030). Female sex was protective (IRR, 0.30; 95% CI, 0.16 to 0.56; P = 0.0002). Conclusions Perioperative ION in spinal fusion significantly decreased from 1998 to 2012 by about 2.7-fold. Aging, male sex, transfusion, and obesity significantly increased the risk.

Background Radical prostatectomy (RP) is most commonly performed laparoscopically with a robot (robotic-assisted laparoscopic radical prostatectomy, R/PROST). Hysterectomy, which may be open hysterectomy (O/HYST), or laparoscopic (L/HYST), has been increasingly frequently done via robot (R/HYST). Small case series suggest increased corneal abrasions (CA) with less invasive techniques. Methods We identified RP (166,942), O/HYST (583,298), or L/HYST (216,890) discharges with CA in the Nationwide Inpatient Sample (2000–2011). For 2009–11, we determined odds ratios (OR) and 95% confidence intervals (CI) for CA, in R/PROST, non-R/PROST, L/HYST, O/HYST, and R/HYST. Uni- and multivariate models studied CA risk depending upon surgical procedure, age, race, year, chronic illness, and malignancy. Results In 2000–11, 0.18% RP, 0.13% L/HYST, and 0.03% O/HYST sustained CA. Compared to 17,554 non-R/PROSTs (34 abrasions, 0.19%) in 2009–11, OR was not significantly higher in 28,521 R/PROSTs (99, 0.35%; OR 1.508, CI 0.987–2.302, P < 0.057). CA significantly increased in L/HYST (70/51,323; 0.136%) vs O/HYST (70/191,199; 0.037%, OR 3.821, CI 2.594–5.630, P < 0.0001), further increasing in R/HYST (63/21, 213; 0.297%, OR 6.505, CI 4.323–9.788, P < 0.0001). For hysterectomy, risk of CA increased with age (OR 1.020, CI 1.007–1.034, P < 0.003), and number of chronic conditions (OR 1.139, CI 1.065–1.219, P < 0.0001). CA risk was likewise elevated in R/HYST with number of chronic conditions. Being African-American significantly decreased CA risk in R/PROST and in R/ or L/HYST. Conclusions L/HYST increased CA nearly 4-fold, and R/HYST about 6.5-fold vs O/HYST. Identifiable preoperative factors are associated with either increased risk (age, chronic conditions) or decreased risk (race).

Our theoretical model aimed at balancing readmissions by extending duration of stay to capture early complications results in a substantial increase in hospital days illustrating the conflict between competing quality metrics and limited resources.