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Perioperative Retinal Artery Occlusion: Incidence and Risk Factors in Spinal Fusion Surgery From the US National Inpatient Sample 1998–2013

Calway, Tyler BS; Rubin, Daniel S. MD; Moss, Heather E. MD, PhD; Joslin, Charlotte E. OD, PhD; Mehta, Ankit I. MD; Roth, Steven MD

doi: 10.1097/WNO.0000000000000544
Original Contribution: PDF Only

Background: Retinal artery occlusion (RAO) is a rare but devastating complication of spinal fusion surgery. We aimed to determine its incidence and associated risk factors.

Methods: Hospitalizations involving spinal fusion surgery were identified by searching the National Inpatient Sample, a database of hospital discharges, from 1998 to 2013. RAO cases were identified using ICD-9-CM codes. Using the STROBE guidelines, postulated risk factors were chosen based on literature review and identified using ICD-9-CM codes. Multivariate logistic models with RAO as outcome, and risk factors, race, age, admission, and surgery type evaluated associations.

Results: Of an estimated 4,784,275 spine fusions in the United States from 1998 to 2013, there were 363 (CI: 291–460) instances of RAO (0.76/10,000 spine fusions, CI: 0.61–0.96). Incidence ranged from 0.35/10,000 (CI: 0.11–1.73) in 2001–2002 to 1.29 (CI: 0.85–2.08) in 2012–2013, with no significant trend over time (P = 0.39). Most strongly associated with RAO were stroke, unidentified type (odds ratio, OR: 14.33, CI: 4.54–45.28, P < 0.001), diabetic retinopathy (DR) (OR: 7.00, CI: 1.18–41.66, P = 0.032), carotid stenosis (OR: 4.94, CI: 1.22–19.94, P = 0.025), aging (OR for age 71–80 years vs 41–50 years referent: 4.07, CI: 1.69–10.84, P = 0.002), and hyperlipidemia (OR: 2.96, CI: 1.85–4.73, P < 0.001). There was an association between RAO and transforaminal lumbar interbody fusion (OR: 2.95, CI: 1.29–6.75, P = 0.010). RAO was more likely to occur with spinal surgery performed urgently or emergently compared with being done electively (OR: 0.40, CI: 0.23–0.68, P < 0.001).

Conclusions: Patient-specific associations with RAO in spinal fusion include aging, carotid stenosis, DR, hyperlipidemia, stroke, and specific types of surgery. DR may serve as an observable biomarker of heightened risk of RAO in patients undergoing spine fusion.

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Rosalind Franklin University Medical School (TC), North Chicago, Illinois; Department of Anesthesia and Critical Care (DSR), the University of Chicago Medicine, Chicago, Illinois; Departments of Ophthalmology and Visual Science (HEM, SR), Neurology and Rehabilitation (HEM), Neurosurgery (AIM), and Anesthesiology (SR), College of Medicine, University of Illinois at Chicago, Chicago, Illinois; Dr. Moss is now with Department of Ophthalmology, Stanford University, Palo Alto, California; Department of Ophthalmology and Visual Science (CEJ), College of Medicine, and School of Epidemiology and Public Health, University of Illinois at Chicago, Chicago, Illinois; and Department of Anesthesia and Critical Care (SR), University of Chicago, Chicago, Illinois.

Address correspondence to Steven Roth, MD, Department of Anesthesiology, University of Illinois Medical Center, 1740 West Taylor Street, MC 515, Chicago, IL 60612; E-mail:

Supported by National Institutes of Health (Bethesda, MD) grants RO1 EY10343 to S. Roth, UL1 RR024999 to the University of Chicago Institute for Translational Medicine, K23 EY024345 to H. E. Moss, UL1 TR000050 to the University of Illinois at Chicago Center for Clinical and Translational Sciences, Core Grant P30 EY001792 to the Department of Ophthalmology of the University of Illinois, a Summer Medical Student Research Grant from The Foundation for Anesthesia Education and Research (Schaumburg, IL) to T. Calway, and an Unrestricted Grant from Research to Prevent Blindness (New York, NY) to the University of Illinois Department of Ophthalmology & Visual Sciences. The funding organizations had no role in the design or conduct of this research.

S. Roth has served as an expert witness in cases of perioperative eye injuries on behalf of patients, physicians, and hospitals. The remaining authors report no conflicts of interest.

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© 2018 by North American Neuro-Ophthalmology Society