Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample.
Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample.
复制标题
脊柱融合手术中的围手术期视觉丧失：1998年至2012年美国在全国住院样本中的缺血性视神经病变。
DOI：
10.1097/aln.0000000000001211
复制
发表时间：
2016-09
期刊：
影响因子：
8.8
通讯作者：
Roth S
中科院分区：
文献类型：
--
作者：
Rubin DS;Parakati I;Lee LA;Moss HE;Joslin CE;Roth S
围手术期缺血性视神经病变（ION）导致脊柱融合术后视力丧失。以往的病例对照研究受限于研究规模和缺乏随机样本。本研究的目的是在一个全国性的大型行政医院数据库中研究脊柱融合术中离子发生率的趋势和危险因素。在1998-2012年的全国住院患者样本（NIS）中，确定了后胸、腰椎或骶骨脊柱融合的手术代码和ION的诊断代码。离子研究分五个三年期进行（1998-2000年、2001-2003年、2004-2006年、2007-2009年和2010-2012年）。国家估计数是在统计调查程序中使用趋势权重获得的。单变量和泊松逻辑回归评估趋势和危险因素。1998-2012年全国胸椎、腰椎和骶骨脊柱融合术的估计体积为2,511,073例。估计有257名患者发生ION（1.02/10,000）。1998 ~ 2012年，ION的发病率比（IRR）显著下降（IRR为0.72 / 3 y， 95%可信区间（CI） 0.58 ~ 0.88, P = 0.002）。视网膜动脉闭塞发生率无明显变化。与ION显著相关的因素有：年龄（IRR为1.24 / 10岁，CI 1.05-1.45, P = 0.009）、输血（IRR为2.72,CI 1.38-5.37, P = 0.004）和肥胖（IRR为2.49,CI 1.09-5.66, P = 0.030）。女性具有保护作用（IRR 0.30, CI 0.16-0.56, P < 0.000）。1998年至2012年，脊柱融合术围手术期离子明显下降约2.7倍。年龄、男性、输血和肥胖显著增加了风险。
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 (NIS) for 1998–2012, procedure codes for posterior thoracic, lumbar or sacral spine fusion, and diagnostic codes for ION were identified. ION was studied over five three-year periods (1998–2000, 2001–2003, 2004–2006, 2007–2009, and 2010–2012). 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 1998–2012 was 2,511,073. ION was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio for ION (IRR) significantly decreased between 1998 and 2012 (IRR 0.72 per 3 y, 95% confidence intervals (CI) 0.58–0.88, 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 y of age, CI 1.05–1.45, P = 0.009), transfusion (IRR 2.72, CI 1.38–5.37, P = 0.004), and obesity (IRR 2.49, CI 1.09–5.66, P = 0.030). Female gender was protective (IRR 0.30, CI 0.16–0.56, P < 0.000). Perioperative ION in spinal fusion significantly decreased from 1998 to 2012 by about 2.7-fold. Aging, male gender, transfusion, and obesity significantly increased the risk.