Predicting Risk of Perioperative Ischemic Optic Neuropathy in Spine Fusion Surgery: A Cohort Study Using the National Inpatient Sample.
Predicting Risk of Perioperative Ischemic Optic Neuropathy in Spine Fusion Surgery: A Cohort Study Using the National Inpatient Sample.
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DOI：
10.1213/ane.0000000000004383
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发表时间：
2020-04
影响因子：
5.7
通讯作者：
Roth S
中科院分区：
文献类型：
--
作者：
Shah SH;Chen YF;Moss HE;Rubin DS;Joslin CE;Roth S
缺血性视神经病变（ION）是一种罕见的麻醉和手术并发症，可导致脊柱融合术中的视力丧失。我们试图根据围手术期ION的已知术前风险因素开发一个预测模型，以指导患者和医生的术前决策。在1998-2012年的国家住院患者样本（NIS）中，识别了后路胸椎、腰椎和骶椎融合术的出院病例，并按ION状态进行分类。使用混合数据的主成分分析（PCA-MIX）通过变量聚类选择变量，而不进行加权。进行具有四个聚类的层次聚类，并选择每个聚类中具有最大平方载荷的变量。通过将我们的样本分为训练和测试数据集，我们开发并内部验证了预测模型。使用术前已知的变量构建最终模型，以确定围手术期发生ION的相对和绝对风险，并进行校准和区分测试。基于分层聚类的最终预测模型包含三个术前因素，年龄，男性或女性性别，以及阻塞性睡眠呼吸暂停（OSA）的存在。基于这些因素的预测模型具有0.65的受试者工作特征曲线下面积和良好的校准。评分临界值> 1具有100%的灵敏度，而评分3具有96.5%的特异性。最高的估计绝对风险（844.5/百万）和相对风险（46.40）的ION是男性，年龄40-64岁，患有OSA。该预测模型可以筛查ION风险较高的患者，以便为脊柱融合术围手术期ION提供更准确的风险评估和手术和麻醉计划。
Ischemic optic neuropathy (ION) is a rare complication of anesthesia and surgery that causes vision loss in spine fusion. We sought to develop a predictive model based upon known pre-operative risk factors for perioperative ION to guide patient and physician pre-operative decision-making. In the National Inpatient Sample (NIS) for 1998–2012, discharges for posterior thoracic, lumbar, and sacral spine fusion were identified and classified by ION status. Variables were selected without weighting via variable clustering using Principal Component Analysis of Mixed Data (PCA-MIX). Hierarchical clustering with four clusters was performed, and the variable with largest squared loading in each cluster was chosen. By splitting our sample into a training and testing data set, we developed and internally validated a predictive model. The final model using variables known pre-operatively was constructed to allow determination of relative and absolute risk of developing perioperative ION, and was tested for calibration and discrimination. The final predictive model based upon hierarchical clustering contained three pre-operative factors, age, male or female sex, and the presence of obstructive sleep apnea (OSA). The predictive model based upon these factors had an area under the receiver operating characteristic curve of 0.65 and good calibration. A score cutoff of > 1 had 100% sensitivity, while score of 3 had 96.5% specificity. The highest estimated absolute risk (844.5/million) and relative risk of ION (46.40) was for a male, age 40–64, with OSA. The predictive model could enable screening for patients at higher risk of ION in order to provide more accurate risk assessment and surgical and anesthetic planning for perioperative ION in spine fusion.