Risk factor anaylysis of perioperative visual loss

围手术期视力丧失(POVL)是一种破坏性的并发症，没有已知的治疗或预防措施， 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)。最高含金量- 登斯参与了美国两种最常见的住院手术。 国家、脊柱融合术和心脏手术。突如其来、意想不到的视觉造成的医疗和经济负担 损失是巨大的；情感损失是不可估量的。了解POVL的危险因素是当务之急 以开发出预防这些致盲并发症的方法。 这里也有一个独特的机会来研究围手术期的自然病史和危险因素 自发性眼疾是导致成年人突然失明的最常见原因之一。A Most POVL的当务之急是预测高危个体。使用国家住院患者样本，PRO- OCT将检查POVL的假设风险因素，并基于这些因素构建预测性风险模型 (目标1)。风险模型将使用一个大型商业保险数据库进行外部验证(AIM 2)。这个 中心假设是，特定的患者因素和特定的手术因素的存在可以预测 发展为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损失(POVL)预测模型 使用NIS的融合和心脏手术，基于文献和 初步数据： 1)围术期RAO和ION与视网膜和/或视神经的原有异常有关； 2)颈动脉狭窄和特定形式的卒中增加了POVL的风险；3)特定的手术因素与POVL的风险有关。 POVL，包括心脏瓣膜手术和脊柱手术的融合程度；4)女性性别意义- 可以降低POVL的风险。 AIM 2将使用Optus对来自AIM 1的预测模型进行外部验证。我们将检验这一假设 在确定风险水平时，患者特有因素和手术因素的组合是协同的，这样，患者的风险水平就会降低。 多起POVL事件是可以先验预测的。 这项研究符合RFA的具体目标，即对现有数据进行分析以产生新的假设。 创新包括：1)将既往眼科疾病与POVL联系起来的新概念，2)使用诊断 和过程性数据，以及建立风险概况指数的统计建模，以及3)与另一个 数据库。除了风险因素确定和风险模型的直接临床相关性外， 两者的翻译意义都是导致外科患者护理发生变化的可能性很高，以及 制定预防战略。潜在的研究意义在于，这些研究将设定 基础工作，以使场垂直推进进入伤害机制。

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.