Newly Published
Perioperative Medicine  |   March 2017
Ischemic Optic Neuropathy in Cardiac Surgery: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013
Author Notes
  • From the Department of Anesthesia and Critical Care (D.S.R., A.T.), and Department of Anesthesia and Critical Care, The Center for Health and the Social Sciences (S.R.), The University of Chicago Medicine, Chicago, Illinois; Pritzker School of Medicine of the University of Chicago, Chicago, Illinois (M.M.M.); Department of Ophthalmology and Visual Science, Department of Neurology and Rehabilitation, College of Medicine, University of Illinois at Chicago, Chicago, Illinois (H.E.M.); Department of Ophthalmology and Visual Science, College of Medicine, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois (C.E.J.); and Department of Anesthesiology, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois (S.R.). Current position: Department of Ophthalmology, Byers Eye Center, Stanford University, Palo Alto, California (H.E.M.).
  • Submitted for publication August 3, 2016. Accepted for publication January 5, 2017.
    Submitted for publication August 3, 2016. Accepted for publication January 5, 2017.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org). Presented in part at the Upper Midwest Neuro-ophthalmology Group Annual Meeting in Chicago, Illinois, July 22, 2016.
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org). Presented in part at the Upper Midwest Neuro-ophthalmology Group Annual Meeting in Chicago, Illinois, July 22, 2016.×
  • Acknowledgments: The authors are grateful to Ms. Chuanhong Liao, M.S., Senior Biostatistician, Department of Public Health Sciences, University of Chicago, Chicago, Illinois, for assistance with the statistical analysis.
    Acknowledgments: The authors are grateful to Ms. Chuanhong Liao, M.S., Senior Biostatistician, Department of Public Health Sciences, University of Chicago, Chicago, Illinois, for assistance with the statistical analysis.×
  • Research Support: Supported by the following grants from the National Institutes of Health (Bethesda, Maryland): RO1 EY10343, to Dr. Roth; UL1 RR024999, to the University of Chicago Institute for Translational Medicine (Chicago, Illinois); UL1 TR002003, to the University of Illinois at Chicago Center for Clinical and Translational Science (Chicago, Illinois); and K23 EY024345, to Dr. Moss. Also supported by core grant no. P30 EY001792 from the Department of Ophthalmology and Visual Sciences of the University of Illinois, the University of Chicago Pritzker School of Medicine Summer Research Program (Chicago, Illinois; to Ms. Matsumoto), and an unrestricted grant from Research to Prevent Blindness (New York, New York; to Dr. Moss, Dr. Joslin, and Dr. Roth) and from the Department of Ophthalmology and Visual Sciences, University of Illinois at (Chicago, Chicago, Illinois; to Dr. Moss, Dr. Joslin, and Dr. Roth).
    Research Support: Supported by the following grants from the National Institutes of Health (Bethesda, Maryland): RO1 EY10343, to Dr. Roth; UL1 RR024999, to the University of Chicago Institute for Translational Medicine (Chicago, Illinois); UL1 TR002003, to the University of Illinois at Chicago Center for Clinical and Translational Science (Chicago, Illinois); and K23 EY024345, to Dr. Moss. Also supported by core grant no. P30 EY001792 from the Department of Ophthalmology and Visual Sciences of the University of Illinois, the University of Chicago Pritzker School of Medicine Summer Research Program (Chicago, Illinois; to Ms. Matsumoto), and an unrestricted grant from Research to Prevent Blindness (New York, New York; to Dr. Moss, Dr. Joslin, and Dr. Roth) and from the Department of Ophthalmology and Visual Sciences, University of Illinois at (Chicago, Chicago, Illinois; to Dr. Moss, Dr. Joslin, and Dr. Roth).×
  • Competing Interests: Dr. Roth has served as an expert witness in cases of perioperative eye injuries on behalf of patients, physicians, and hospitals. The other authors declare no competing interests.
    Competing Interests: Dr. Roth has served as an expert witness in cases of perioperative eye injuries on behalf of patients, physicians, and hospitals. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Rubin: Department of Anesthesia and Critical Care, University of Chicago Medicine, 5841 South Maryland, Box M.C. 4028, Chicago, Illinois 60637. drubin@dacc.uchicago.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Ophthalmologic Anesthesia
Perioperative Medicine   |   March 2017
Ischemic Optic Neuropathy in Cardiac Surgery: Incidence and Risk Factors in the United States from the National Inpatient Sample 1998 to 2013
Anesthesiology Newly Published on March 2, 2017. doi:10.1097/ALN.0000000000001533
Anesthesiology Newly Published on March 2, 2017. doi:10.1097/ALN.0000000000001533
Abstract

Background: Ischemic optic neuropathy is the most common form of perioperative visual loss, with highest incidence in cardiac and spinal fusion surgery. To date, potential risk factors have been identified in cardiac surgery by only small, single-institution studies. To determine the preoperative risk factors for ischemic optic neuropathy, the authors used the National Inpatient Sample, a database of inpatient discharges for nonfederal hospitals in the United States.

Methods: Adults aged 18 yr or older admitted for coronary artery bypass grafting, heart valve repair or replacement surgery, or left ventricular assist device insertion in National Inpatient Sample from 1998 to 2013 were included. Risk of ischemic optic neuropathy was evaluated by multivariable logistic regression.

Results: A total of 5,559,395 discharges met inclusion criteria with 794 (0.014%) cases of ischemic optic neuropathy. The average yearly incidence was 1.43 of 10,000 cardiac procedures, with no change during the study period (P = 0.57). Conditions increasing risk were carotid artery stenosis (odds ratio, 2.70), stroke (odds ratio, 3.43), diabetic retinopathy (odds ratio, 3.83), hypertensive retinopathy (odds ratio, 30.09), macular degeneration (odds ratio, 4.50), glaucoma (odds ratio, 2.68), and cataract (odds ratio, 5.62). Female sex (odds ratio, 0.59) and uncomplicated diabetes mellitus type 2 (odds ratio, 0.51) decreased risk.

Conclusions: The incidence of ischemic optic neuropathy in cardiac surgery did not change during the study period. Development of ischemic optic neuropathy after cardiac surgery is associated with carotid artery stenosis, stroke, and degenerative eye conditions.