Risk factor anaylysis of perioperative visual loss

围手术期视力丧失的危险因素分析

• 批准号: 9388049
• 负责人: STEVEN ROTH
• 金额: $ 25.19万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9388049
• 关键词: Adult; Aging; American; Anemia; Animals; Atherosclerosis; Blindness; Cardiac Surgery procedures; Caring; Carotid Stenosis; Case Series; Case Study; Case-Control Studies; Chronic; Clinical Research; Colloids; Complication; Coronary Artery Bypass; Cortical Blindness; Data; Data Collection; Databases; Development; Diabetes Mellitus; Diabetic Retinopathy; Diagnostic; Disease; Economic Burden; Embolism; Emotional; Eye; Eye diseases; Female; Foundations; Glaucoma; Goals; Head; Healthcare; Hemodilution; Hemorrhage; Human; Hypertension; Hypotension; Incidence; Individual; Injury; Inpatients; Institution; Insurance; Intervention; Intervention Studies; Ischemic Optic Neuropathy; Life; Liquid substance; Literature; Litigation; Macular degeneration; Medical; Medical Economics; Medicare claim; Mission; Modeling; Natural History; Obesity; Odds Ratio; Operative Surgical Procedures; Optic Nerve; Patient risk; Patients; Perioperative; Perioperative Care; Positioning Attribute; Postoperative Period; Prevention; Prevention strategy; Procedures; Productivity; Recording of previous events; Registries; Reporting; Research; Resuscitation; Retina; Retinal; Risk; Risk Factors; Sampling; Series; Shapes; Sleep Apnea Syndromes; Spinal Fusion; Spine surgery; Statistical Models; Stroke; Testing; Thrombocytopenia; United States; Validation; Vasoconstrictor Agents; Vertebral column; Vision Disorders; Visual impairment; aortic valve; artery occlusion; base; clinically relevant; cost; crystalloid; data modeling; high risk; indexing; innovation; male; middle age; novel; operation; predictive modeling; prevent; protective effect; sex

Perioperative visual loss (POVL) is a devastating complication, with no known treatment or prevention, most commonly due to ischemic optic neuropathy (ION), or retinal arterial occlusion (RAO). The highest inci- dence is associated with two of the most commonly performed inpatient surgical procedures in the United States, spinal fusion, and cardiac surgery. The medical and economic burden of sudden, unexpected visual loss is considerable; the emotional toll is immeasurable. It is imperative to understand the risk factors for POVL in order to develop means to prevent these blinding complications. There also exists here a unique opportunity to study the natural history and risk factors for perioperative and spontaneous eye diseases that are among the most common causes of sudden adult vision loss. A most pressing problem in POVL is predicting the high risk individual. Using the National Inpatient Sample, the pro- ject will examine postulated risk factors for POVL, and construct a predictive risk model based on these factors (Aim 1). The risk model will be externally validated using a large commercial insurance database (Aim 2). The central hypothesis is that the presence of specific patient factors, and specific surgical factors, can predict the risk of developing POVL. Aim 1 will study risk factors and develop a predictive model for perioperative visual loss (POVL) in spinal fusion and cardiac surgery using the NIS, with the following specific hypotheses based on the literature and preliminary data: 1) Perioperative RAO and ION are associated with pre-existing abnormalities of the retina and/or optic nerve; 2) Carotid stenosis and specific forms of stroke increase risk of POVL; 3) Specific surgical factors are associ- ated with POVL, including valvular heart surgery, and extent of fusions in spine surgery; 4) Female sex signifi- cantly decreases risk of POVL. Aim 2 will externally validate the predictive model from Aim 1 using Optum. We will test the hypothesis that combinations of patient specific and surgical factors are synergistic in defining risk level, such that the ma- jority of POVL incidents are predictable a priori. The research fits the specific goals of this RFA for 2o analysis of existing data to generate new hypotheses. Innovation includes: 1) the new concept relating pre-existing ophthalmic disease to POVL, 2) using diagnostic and procedural data, and statistical modeling to build a risk profile index, and 3) cross-validation with another database. In addition to direct clinical relevance of both the risk factor determination and the risk model, the translational significance of both is the high likelihood of resulting changes in the care of surgical patients, and development of prevention strategies. The underlying research significance is that the studies will set the groundwork to enable vertical advancement of the field into mechanisms of injury.

围手术期视力丧失（POVL）是一种毁灭性的并发症，没有已知的治疗或预防， 最常见的原因是缺血性视神经病变（ION）或视网膜动脉阻塞（RAO）。最高的inci- 证据与美国最常见的两种住院外科手术有关。 脊柱融合术和心脏手术。突发性、意外性视力损害的医疗和经济负担 损失是相当大的;感情上的损失是不可估量的。了解POVL的危险因素是当务之急 以开发预防这些致盲并发症的方法。 这里也存在一个独特的机会，研究自然史和围手术期的风险因素， 和自发性眼病，这是成人突然失明的最常见原因。一个最 POVL中的紧迫问题是预测高危个体。使用全国住院患者样本，亲- 受试者将检查POVL的假定风险因素，并根据这些因素构建预测风险模型 (Aim 1）。将利用一个大型商业保险数据库对风险模型进行外部验证（目标2）。的 中心假设是，特定患者因素和特定手术因素的存在可以预测 发展的风险。 目的1研究脊柱手术围手术期视力丧失的危险因素并建立预测模型。 使用NIS的融合和心脏手术，基于文献和以下特定假设， 初步数据： 1)围手术期RAO和ION与视网膜和/或视神经的既存异常相关; 2)颈动脉狭窄和特定形式的卒中增加POVL的风险; 3）特定的手术因素与POVL相关。 POVL，包括心脏瓣膜手术，以及脊柱手术中的融合程度; 4）女性性别显著 降低POVL的风险。 目标2将使用Optum从外部验证目标1的预测模型。我们将检验这个假设 患者特异性因素和手术因素的组合在定义风险水平时是协同作用的，因此， 大部分POVL事件是可以事先预测的。 该研究符合RFA的具体目标，即对现有数据进行分析以产生新的假设。 创新包括：1）将既存眼科疾病与POVL联系起来的新概念，2）使用诊断 和程序数据，以及统计建模，以建立风险状况指数，以及3）与另一个交叉验证 数据库除了风险因素确定和风险模型两者的直接临床相关性之外， 两者的转化意义是手术患者护理发生变化的可能性很高， 制定预防战略。其研究意义在于， 奠定基础，使场能够垂直推进到伤害机制中。