Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery
Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery
复制标题
DOI：
10.1097/aln.0b013e31823d012a
复制
发表时间：
2012-01-01
期刊：
影响因子：
8.8
通讯作者：
Metzner, Julia
中科院分区：
文献类型：
--
作者：
Lee, Lorri A.;Roth, Steven;Metzner, Julia
工作背景：围手术期视力丧失是脊柱融合手术的一种罕见但可怕的并发症，最常见的原因是缺血性视神经病变（ION）。作者试图确定在这种setting.Methods的ION的危险因素：采用多中心病例对照设计，作者比较了80例成人患者与ION从美国麻醉医师学会术后视力丧失登记与315例成人对照组无ION脊柱融合手术后，随机选择17个机构，并匹配的手术年。采用逐步多变量分析法对患者和对照组患者的既往医疗状况和围手术期因素进行比较，以评估可能预测ION的因素。多因素分析后，脊柱融合术后ION的危险因素包括男性（比值比[OR] 2.53，95% CI 1.35-4.91，P = 0.005），肥胖（OR 2.83，95% CI 1.52-5.39，P = 0.001），Wilson框架使用（OR 4.30，95%CI 2.13-8.75，P < 0.001），麻醉时间（每1 h的OR = 1.39，95% CI 1.22-1.58，P < 0.001），估计失血量非血液替代的胶体百分比（OR/5% = 0.67，95%CI 0.52-0.82，P < 0.001）。交叉验证后，曲线下面积= 0.85，敏感性= 0.79，特异性= 0.82。结论：这是第一个以大规模、多中心病例对照方式评估ION危险因素的研究，有详细的围手术期数据。肥胖、男性、Wilson支架使用、麻醉持续时间较长、估计失血量较大和胶体给药百分比降低与脊柱融合术后ION显著独立相关。
Background: Perioperative visual loss, a rare but dreaded complication of spinal fusion surgery, is most commonly caused by ischemic optic neuropathy (ION). The authors sought to determine risk factors for ION in this setting.Methods: Using a multicenter case-control design, the authors compared 80 adult patients with ION from the American Society of Anesthesiologists Postoperative Visual Loss Registry with 315 adult control subjects without ION after spinal fusion surgery, randomly selected from 17 institutions, and matched by year of surgery. Preexisting medical conditions and perioperative factors were compared between patients and control subjects using stepwise multivariate analysis to assess factors that might predict ION.Results: After multivariate analysis, risk factors for ION after spinal fusion surgery included male sex (odds ratio [OR] 2.53, 95% CI 1.35-4.91, P = 0.005), obesity (OR 2.83, 95% CI 1.52-5.39, P = 0.001), Wilson frame use (OR 4.30, 95% CI 2.13-8.75, P < 0.001), anesthesia duration (OR per 1 h = 1.39, 95% CI 1.22-1.58, P < 0.001), estimated blood loss (OR per 1 l = 1.34, 95% CI 1.13-1.61, P = 0.001), and colloid as percent of nonblood replacement (OR per 5% = 0.67, 95% CI 0.52-0.82, P < 0.001). After cross-validation, area under the curve = 0.85, sensitivity = 0.79, and specificity = 0.82.Conclusions: This is the first study to assess ION risk factors in a large, multicenter case-control fashion with detailed perioperative data. Obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration were significantly and independently associated with ION after spinal fusion surgery.