title: Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database.
abstract: BACKGROUND
  Perioperative visual loss (POVL) after spinal deformity surgery is an uncommon but severe complication. Data on the incidence and risk factors of this complication after corrective surgery in the pediatric population are limited.
  
  
  OBJECTIVE
  The present study aimed to investigate nationwide estimates of POVL after corrective surgery for pediatric scoliosis.
  
  
  METHODS
  This is a retrospective study that uses a nationwide database.
  
  
  METHODS
  The sample includes 42,339 patients under the age of 18 who underwent surgery for idiopathic scoliosis.
  
  
  METHODS
  The outcome measures were incidence of POVL and risk factors.
  
  
  METHODS
  Patients under the age of 18 who underwent elective surgery for idiopathic scoliosis between 2002 and 2011 were identified using the Nationwide Inpatient Sample database. The incidence of POVL (ischemic optic neuropathy, central retinal artery occlusion, or cortical blindness) was estimated after application of discharge weights. Demographics, comorbidities, and operative parameters were compared between patients with and without visual loss. A multivariate logistic regression was performed to identify significant risk factors for POVL development. No funds were received in support of this work.
  
  
  RESULTS
  The incidence of POVL was 1.6 per 1,000 procedures (0.16%). Patients with visual loss were significantly more likely to be younger and male, have Medicaid as insurance, and undergo fusion of eight or more spinal levels compared with patients without visual loss. Following multivariate analysis, older patients (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.77-0.91) and female patients (OR: 0.08; 95% CI: 0.04-0.14) were significantly less likely to develop POVL compared with younger and male patients. On the other hand, having Medicaid as insurance (OR: 2.13;95% CI: 1.32-3.45), history of deficiency anemia (OR: 8.64; 95% CI: 5.46-14.31), and fusion of eight or more spinal levels (OR: 2.40; 95% CI: 1.34-4.30) were all independently associated with POVL.
  
  
  CONCLUSIONS
  In this nationwide study, the incidence of POVL after scoliosis surgery in patients under the age of 18 was estimated at 0.16%, similar to the rate reported in adult patients. Cortical blindness accounted for all cases of POVL in the present study. Younger patients, patients with history of deficiency anemia, and patients undergoing long-segment fusions may be at increased risk of POVL after corrective surgery for pediatric scoliosis.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 5-185, Baltimore, MD 21287, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.affiliation: Shriners Hospitals for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St #5212, Baltimore, MD 21287, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St #5212, Baltimore, MD 21287, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ain
authors.affiliation: Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St # 229, Baltimore, MD 21287, USA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, 1215 Lee St, Charlottesville, VA 22908, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 5-185, Baltimore, MD 21287, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000293:Adolescent; D001766:Blindness / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D014481:United States
keywords: Adolescent idiopathic scoliosis; Cortical blindness; Infantile scoliosis; Juvenile idiopathic scoliosis; Nationwide Inpatient Sample; Visual loss