Perioperative visual loss after excision and autografting of a thermal burn to the back.
Peri-operative visual loss is an uncommon and poorly understood entity whose severity launched a Practice Advisory to identify peri-operative risk factors including prone positioning, anemia, hypotension, blood loss >44.7% of EBV, and surgical time >4-6.5 h. Contributing co-morbidities are obesity, tobacco, malnutrition, and PAD, which reduce blood flow to the optic nerve. We describe a patient with POVL focusing on the peri-operative course defined as the immediate preoperative assessment through discharge to compare the hospital course with previous reports of POVL in cardiac and spine operations.ss A middle-aged man admitted to the burn unit with 10% deep partial and full thickness burns to the back and neck underwent excision and autografting while prone. He was subsequently diagnosed with ischemic optic neuropathy and blindness. Co-morbidities were tobacco, malnutrition (albumin of 2.6 g/dl), and obesity (BMI 30.1). Preoperative risk assessment included anemia and prone positioning. Intra-operative hypotension to SBP 75 mmHg was noted. Operative duration was 5 h. Blood loss was estimated to be 43.7% of EBV. Risk factors for POVL are present in many prone burn operations as these patients have long operative times and significant blood loss. Thus, minimization of these factors where possible is advised.
Department of General Surgery, University of Colorado Hospital, 12605 E. 16th Ave., Mail Stop F796, Aurora, CO 80045, United States; Thomas Jefferson University, 1025 Walnut St. Suite 620, Philadelphia, PA 19107, United States; Division of Burn Surgery, University of Colorado Hospital, 12605 E. 16th Ave., Mail Stop F796, Aurora, CO 80045, United States. Electronic address: thea.p.price@gmail.com.
Thea P
TP
Price
Thomas Jefferson University, 1025 Walnut St. Suite 620, Philadelphia, PA 19107, United States; Division of Burn Surgery, University of Colorado Hospital, 12605 E. 16th Ave., Mail Stop F796, Aurora, CO 80045, United States.
Anna
A
Ivashchenko
Thomas Jefferson University, 1025 Walnut St. Suite 620, Philadelphia, PA 19107, United States; Division of Burn Surgery, University of Colorado Hospital, 12605 E. 16th Ave., Mail Stop F796, Aurora, CO 80045, United States.
Michael J
MJ
Schurr
D000740:Anemia / Q000150:complications; D001415:Back / Q000601:surgery*; D016063:Blood Loss, Surgical; D002056:Burns / Q000150:complications / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000150:complications; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D061646:Operative Time; D018917:Optic Neuropathy, Ischemic / Q000209:etiology*; D056888:Patient Positioning / Q000009:adverse effects*; D016684:Prone Position; D012307:Risk Factors; D016038:Skin Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D014786:Vision Disorders / Q000209:etiology*
Blindness; Burn; Peri operative vision loss; Prone positioning; Thermal injury