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. 2016 Sep;125(3):457-64.
doi: 10.1097/ALN.0000000000001211.

Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample

Daniel S Rubin  1 , Isaac Parakati, Lorri A Lee, Heather E Moss, Charlotte E Joslin, Steven Roth
Affiliations

Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample

Daniel S Rubin et al. Anesthesiology. 2016 Sep.

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.

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Conflict of interest statement

Drs. Roth and Lee have served as expert witnesses in cases of perioperative eye injuries on behalf of patients, physicians, and hospitals.

Figures

Figure 1
Figure 1
The Y-axis shows the three year incidence of ION (ischemic optic neuropathy) and RAO (retinal artery occlusion) per time period (x-axis), using national estimates from the NIS. The data are shown as incidence point estimates +/− 95% confidence intervals. Three year periods were used, as AHRQ does not allow reporting results < 10. The incidence of ION, but not RAO, significantly decreased over time
See this image and copyright information in PMC

Comment in

References

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