Incidence and risk factors for perioperative visual loss after spinal fusion

Abstract

Background context: Perioperative visual loss (POVL) is a rare but devastating complication that may follow spinal surgeries. The incidence of POVL after spinal fusion is not well characterized during the past decade.

Purpose: A population-based database was analyzed to characterize the incidence and risk factors for POVL associated with spinal fusion surgery on a national level.

Study design: This study consisted of a retrospective database analysis.

Patient sample: A total of 541,485 patients from the Nationwide Inpatient Sample (NIS) database were included in the study.

Outcome measures: Study outcome measures included incidence of POVL, length of stay (LOS), in-hospital costs, mortality, and POVL risk factors.

Methods: Data from the NIS were obtained from 2002 to 2009. Patients undergoing spinal fusion for degenerative pathologies were identified. Patient demographics, comorbidities, LOS, costs, and mortality were assessed. Statistical analyses were conducted using an independent t test for discrete variables and the chi-square test for categorical data. Binomial logistic regression was used to identify independent predictors of POVL. A p value of less than or equal to .001 was used to denote statistical significance. No funds were received by any of the authors for production of this study.

Results: A total of 541,485 spinal fusions were identified in the United States from 2002 to 2009. The overall incidence of POVL was 1.9 events per 10,000 cases. Of patients who had POVL, 56.2% underwent surgery for a diagnosis of spinal deformity. Patients with POVL were significantly younger on average compared with unaffected patients (37.6 years vs. 52.4 years; p<.001). Length of stay and hospital costs doubled for patients with POVL (p<.001). Logistic regression analysis demonstrated that independent predictors of visual loss were deformity surgery (odds ratio [OR]=6.1), diabetes mellitus with end organ damage (OR=13.1), and paralysis (OR=6.0, p<.001).

Conclusions: Our findings demonstrated an overall POVL incidence of 1.9 events per 10,000 spinal fusions. Patients undergoing thoracic fusion for deformity correction accounted for the majority of cases of POVL. Despite being a rare complication after spinal fusion, POVL is an adverse event that may not be entirely preventable. Patients undergoing long-segment fusions for deformity and those with certain risk factors should be counseled regarding the risks of POVL.

Keywords: Complications; Ischemia optic neuropathy; Nationwide inpatient sample; Perioperative visual loss; Risk factors; Spinal deformity; Spinal fusion.