title: Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: From 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.).
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Rubin
authors.forename: Isaac
authors.initials: I
authors.lastname: Parakati
authors.forename: Lorri A
authors.initials: LA
authors.lastname: Lee
authors.forename: Heather E
authors.initials: HE
authors.lastname: Moss
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Joslin
authors.forename: Steven
authors.initials: S
authors.lastname: Roth
mesh_terms: D000367:Age Factors; D001766:Blindness / Q000453:epidemiology*; D001803:Blood Transfusion; D015984:Causality; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D018917:Optic Neuropathy, Ischemic / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology