The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery

Anesth Analg. 2009 Nov;109(5):1534-45. doi: 10.1213/ane.0b013e3181b0500b. Epub 2009 Aug 27.


Background: Perioperative visual loss (POVL) accompanying nonocular surgery is a rare and potentially devastating complication but its frequency in commonly performed inpatient surgery is not well defined. We used the Nationwide Inpatient Sample to estimate the rate of POVL in the United States among the eight most common nonocular surgeries.

Methods: More than 5.6 million patients in the Nationwide Inpatient Sample who underwent principal procedures of knee arthroplasty, cholecystectomy, hip/femur surgical treatment, spinal fusion, appendectomy, colorectal resection, laminectomy without fusion, coronary artery bypass grafting, and cardiac valve procedures from 1996 to 2005 were included. Rates of POVL, defined as any discharge with an International Classification of Diseases, Ninth Revision, Clinical Modification code of ischemic optic neuropathy (ION), cortical blindness (CB), or retinal vascular occlusion (RVO), were estimated. Potential risk factors were assessed by univariate and multivariable analyses.

Results: Cardiac and spinal fusion surgery had the highest rates of POVL. The national estimate in cardiac surgery was 8.64/10,000 and 3.09/10,000 in spinal fusion. By contrast, POVL after appendectomy was 0.12/10,000. Those undergoing cardiac surgery, spinal fusion, and orthopedic surgery had a significantly increased risk of developing ION, RVO, or CB. Patients younger than 18 yr had the highest risk for POVL, because of higher risk for CB, whereas those older than 50 yr were at greater risk of developing ION and RVO. Other significant positive predictors for some diagnoses of POVL were male gender, Charlson comorbidity index, anemia, and blood transfusion. There was no increased risk associated with hospital surgical volume. During the 10 yr from 1996 to 2005, there was an overall decrease in POVL in the procedures we studied.

Conclusions: The results confirm the clinical suspicion that the risk of POVL is higher in cardiac and spine fusion surgery and show for the first time a higher risk of this complication in patients undergoing lower extremity joint replacement surgery. The prevalence of POVL in the eight most commonly performed surgical operations in the United States has decreased between 1996 and 2005. Increased odds of POVL with male gender and comorbidity index indicate that some risk factors for POVL may not presently be modifiable. The conclusions of this study are limited by factors affecting data accuracy, such as lack of data on the intraoperative course and inability to confirm the diagnostic coding of any of the discharges in the database.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Anemia / complications
  • Anemia / epidemiology
  • Blindness, Cortical / epidemiology
  • Blindness, Cortical / etiology
  • Cardiac Surgical Procedures / adverse effects*
  • Comorbidity
  • Databases as Topic
  • Digestive System Surgical Procedures / adverse effects*
  • Female
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Optic Neuropathy, Ischemic / epidemiology
  • Optic Neuropathy, Ischemic / etiology
  • Orthopedic Procedures / adverse effects*
  • Prevalence
  • Retinal Diseases / epidemiology
  • Retinal Diseases / etiology
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Spinal Cord / surgery*
  • Time Factors
  • Transfusion Reaction
  • Treatment Outcome
  • United States / epidemiology
  • Vision Disorders / epidemiology*
  • Vision Disorders / etiology
  • Young Adult