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，目前尚无已知的治疗或预防方法， 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- 疾病与美国两种最常进行的住院外科手术有关 状态、脊柱融合和心脏手术。突然、意外的视力造成的医疗和经济负担 损失相当大；情感上的损失是无法估量的。必须了解 POVL 的危险因素 以开发预防这些致盲并发症的方法。 这里还存在一个独特的机会来研究围手术期的自然史和风险因素 和自发性眼病是成人突然视力丧失的最常见原因之一。一个最 POVL 中的紧迫问题是预测高风险个体。使用全国住院患者样本，亲 ject 将检查 POVL 的假设风险因素，并根据这些因素构建预测风险模型 （目标 1）。风险模型将使用大型商业保险数据库进行外部验证（目标 2）。这 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 发生 POVL 的风险。 目标 1 将研究危险因素并开发脊柱围手术期视力丧失 (POVL) 的预测模型 使用 NIS 进行融合和心脏手术，根据文献和文献提出以下具体假设 初步数据： 1) 围手术期 RAO 和 ION 与先前存在的视网膜和/或视神经异常有关； 2）颈动脉狭窄和特定形式的中风会增加POVL的风险； 3）特定的手术因素是相关的 与 POVL 相关，包括心脏瓣膜手术和脊柱手术中的融合程度； 4）女性性别意义 无法降低 POVL 的风险。 目标 2 将使用 Optum 从外部验证目标 1 的预测模型。我们将检验假设 患者特定因素和手术因素的组合在定义风险水平时具有协同作用，因此主要 大多数 POVL 事件都是可以先验预测的。 这项研究符合 RFA 的具体目标，即对现有数据进行 2o 分析以产生新的假设。 创新包括：1) 将已有眼科疾病与 POVL 联系起来的新概念，2) 使用诊断方法 和程序数据以及统计建模来构建风险概况指数，以及 3）与另一个交叉验证 数据库。除了危险因素确定和风险模型的直接临床相关性之外， 两者的转化意义在于很可能导致手术患者的护理发生变化，并且 制定预防策略。研究的根本意义在于，该研究将设定 使该领域能够垂直推进到损伤机制的基础工作。