Rubin Daniel S, Parakati Isaac, Lee Lorri A, Moss Heather E, Joslin Charlotte E, Roth Steven
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.).
Anesthesiology. 2016 Sep;125(3):457-64. doi: 10.1097/ALN.0000000000001211.
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.
围手术期缺血性视神经病变（ION）可导致脊柱融合手术患者视力丧失。以往的病例对照研究受限于研究规模且缺乏随机抽样。本研究旨在利用一个大型的全国性行政医院数据库，研究脊柱融合手术中ION的发病率趋势及危险因素。
在1998年至2012年的全国住院患者样本中，确定了胸段、腰段或骶段脊柱后路融合手术的操作代码以及ION的诊断代码。对ION在五个3年时间段（1998年至2000年、2001年至2003年、2004年至2006年、2007年至2009年以及2010年至2012年）进行研究。使用统计调查程序中的趋势权重获得全国估计值。单因素分析和泊松逻辑回归评估趋势和危险因素。
1998年至2012年全国估计的胸段、腰段和骶段脊柱融合手术量为2511073例。估计有257例患者发生ION（1.02/10000）。1998年至2012年期间ION的发病率比（IRR）显著下降（IRR，每3年0.72；95%CI，0.58至0.88；P = 0.002）。视网膜动脉阻塞的发病率无显著变化。与ION显著相关的因素包括年龄（IRR，每增加10岁为1.24；95%CI，1.05至1.45；P = 0.009）、输血（IRR，2.72；95%CI，1.38至5.37；P = 0.004）和肥胖（IRR，2.49；95%CI，1.09至5.66；P = 0.030）。女性具有保护作用（IRR，0.30；95%CI，0.16至0.56；P = 0.0002）。
1998年至2012年期间，脊柱融合手术中的围手术期ION显著下降了约2.7倍。年龄增长、男性、输血和肥胖显著增加了风险。
