title: Perioperative Retinal Artery Occlusion: Risk Factors in Cardiac Surgery from the United States National Inpatient Sample 1998-2013.
abstract: To study the incidence and risk factors for retinal artery occlusion (RAO) in cardiac surgery.
  
  
  
  Retrospective study using the National Inpatient Sample (NIS).
  
  
  
  The NIS was searched for cardiac surgery. Retinal artery occlusion was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Postulated risk factors based on literature review were included in multivariate logistic models.
  
  
  
  Diagnosis of RAO.
  
  
  
  A total of 5 872 833 cardiac operative procedures were estimated in the United States from 1998 to 2013, with 4564 RAO cases (95% confidence interval [95% CI], 4282-4869). Nationally estimated RAO incidence was 7.77/10 000 cardiac operative procedures from 1998 to 2013 (95% CI, 7.29-8.29). Associated with increased RAO were giant cell arteritis (odds ratio [OR], 7.73; CI, 2.78-21.52; P < 0.001), transient cerebral ischemia (OR, 7.67; CI, 5.31-11.07; P < 0.001), carotid artery stenosis (OR, 7.52; CI, 6.22-9.09; P < 0.001), embolic stroke (OR, 4.43; CI, 3.05-6.42; P < 0.001), hypercoagulability (OR, 2.90; CI, 1.56-5.39; P < 0.001), myxoma (OR, 2.43; CI, 1.39-4.26; P = 0.002), diabetes mellitus (DM) with ophthalmic complications (OR, 1.89; CI, 1.10-3.24; P = 0.02), and aortic insufficiency (OR, 1.85; CI, 1.26-2.71; P = 0.002). Perioperative bleeding, aortic and mitral valve surgery, and septal surgery increased the odds of RAO. Negatively associated with RAO were female gender (OR, 0.77; CI, 0.66-0.89; P < 0.001), thrombocytopenia (OR, 0.79; CI, 0.62-1.00; P = 0.049), acute coronary syndrome (OR, 0.72; CI, 0.58-0.89; P = 0.003), atrial fibrillation (OR, 0.82; CI, 0.70-0.95; P = 0.01), congestive heart failure (OR, 0.73; CI, 0.60-0.88; P < 0.001), DM 2 (OR, 0.74; CI, 0.61-0.89; P = 0.001), and smoking (OR, 0.82; CI, 0.70-0.97; P = 0.02).
  
  
  
  Risk factors for RAO in cardiac surgery include giant cell arteritis, carotid stenosis, stroke, hypercoagulable state, and DM with ophthalmic complications; associated with lower risk were female gender, thrombocytopenia, acute coronary syndrome, atrial fibrillation, congestive heart failure, DM 2, and smoking. Surgery in which the heart was opened (e.g., septal repair) versus surgery in which it was not (e.g., CABG) and perioperative bleeding increased the risk of RAO.
authors.affiliation: Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
authors.forename: Tyler
authors.initials: T
authors.lastname: Calway
authors.affiliation: Department of Anesthesia and Critical Care, the University of Chicago Medicine, Chicago, Illinois.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Rubin
authors.affiliation: Department of Ophthalmology, Byers Eye Center, Stanford University Medical Center, Palo Alto, California.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Moss
authors.affiliation: Department of Ophthalmology and Visual Science, College of Medicine, and School of Epidemiology and Public Health, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Joslin
authors.affiliation: Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Katharina
authors.initials: K
authors.lastname: Beckmann
authors.affiliation: Department of Anesthesiology and Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. Electronic address: rothgas@uic.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Roth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D015356:Retinal Artery Occlusion / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult