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Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012
Daniel S Rubin1, Isaac Parakati, Lorri A Lee
1From the Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois (D.S.R.); College of the University of Chicago, Chicago, Illinois (I.P.); Department of Anesthesiology (L.A.L.) and Neuroanesthesia (L.A.L.), Vanderbilt University, Nashville, Tennessee; Departments of Ophthalmology and Visual Sciences (H.E.M., C.E.J., S.R.), Neurology and Rehabilitation (H.E.M.), and Anesthesiology (S.R.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois (C.E.J.); and Department of Anesthesia and Critical Care (S.R.) and The Center for Health and the Social Sciences (S.R.), University of Chicago Medicine, Chicago, Illinois. Current position: Department of Biostatistics, Emory University, Atlanta, Georgia (I.P.).
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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