Perioperative Visual Loss in Spine Fusion Surgery

Abstract

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.

Visual Loss After Lateral Position Total Hip Arthroplasty: A Case Report

“…Over the past few decades, more and more cases of POVL of nonocular surgery had been gradually reported that were mainly concentrated in the spine and cardiac surgery [6,7]. We present this patient who experienced POVL following total hip arthroplasty performed in the lateral position, and we have many assumptions for etiology and diagnosis of this patient.…”

Ischemic Optic Neuropathy in Cardiac Surgery

“…However, our un-weighted sample size is > 1 million admissions, which mitigates systematic reporting bias and previous studies have used the NIS to identify the incidence of ION in various surgical populations. 8 …”

“…We used these updated “trend weights,” combined with the “survey” function for all patient level analysis and regressions, as previously described. 8 The University of Chicago and University of Illinois Institutional Review Boards deemed the study exempt from IRB review since there are no patient identifiers.…”

“…AHRQ trend weights, and the survey functions of STATA were used for all national estimates and regressions. 8 Dividing individual survey estimates from the total count can lead to rounding variation in the NIS dataset, as seen in the total number of ION cases when compared to cases of ION for the different cardiac procedures. Data were complete except for race (n=1,261,433 [23%]), type of admission (n=1,692,552 [30%]), age (n=433, [0.01%]), length of stay (n=185 [<0.01%]) and discharge status (n=7,316 [0.1%]).…”

Intraocular Pressure Changes With Positioning During Laparoscopy

“…1 Visual loss after surgery has been attributed to ischemic optic neuropathy (ION), cortical blindness (CB), or retinal vascular occlusion (RVO). 2–4 Although the immediate cause of these remain unclear, reduction in ocular perfusion is central to all of the pathways. 5,6 Ocular perfusion pressure, which is determined by the difference between main arterial pressure (MAP) and intraocular pressure (IOP) is known to be altered in surgical procedures where significant IOP fluctuations may occur.…”