Risk factor anaylysis of perioperative visual loss

围手术期视力丧失的危险因素分析

• 批准号: 9388049
• 负责人: STEVEN ROTH
• 金额: $ 25.19万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9388049
• 关键词: Adult; Aging; American; Anemia; Animals; Atherosclerosis; Blindness; Cardiac Surgery procedures; Caring; Carotid Stenosis; Case Series; Case Study; Case-Control Studies; Chronic; Clinical Research; Colloids; Complication; Coronary Artery Bypass; Cortical Blindness; Data; Data Collection; Databases; Development; Diabetes Mellitus; Diabetic Retinopathy; Diagnostic; Disease; Economic Burden; Embolism; Emotional; Eye; Eye diseases; Female; Foundations; Glaucoma; Goals; Head; Healthcare; Hemodilution; Hemorrhage; Human; Hypertension; Hypotension; Incidence; Individual; Injury; Inpatients; Institution; Insurance; Intervention; Intervention Studies; Ischemic Optic Neuropathy; Life; Liquid substance; Literature; Litigation; Macular degeneration; Medical; Medical Economics; Medicare claim; Mission; Modeling; Natural History; Obesity; Odds Ratio; Operative Surgical Procedures; Optic Nerve; Patient risk; Patients; Perioperative; Perioperative Care; Positioning Attribute; Postoperative Period; Prevention; Prevention strategy; Procedures; Productivity; Recording of previous events; Registries; Reporting; Research; Resuscitation; Retina; Retinal; Risk; Risk Factors; Sampling; Series; Shapes; Sleep Apnea Syndromes; Spinal Fusion; Spine surgery; Statistical Models; Stroke; Testing; Thrombocytopenia; United States; Validation; Vasoconstrictor Agents; Vertebral column; Vision Disorders; Visual impairment; aortic valve; artery occlusion; base; clinically relevant; cost; crystalloid; data modeling; high risk; indexing; innovation; male; middle age; novel; operation; predictive modeling; prevent; protective effect; sex

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.

围手术期视觉丧失（POVL）是一种破坏性的并发症，没有已知的治疗或预防， 最常见的是缺血性视神经病变（离子）或视网膜动脉闭塞（RAO）。最高的 Dence与联合的两个最常见的住院手术程序有关 状态，脊柱融合和心脏手术。突然，意外视觉的医疗和经济负担 损失很大；情感上的伤害是不可估量的。必须了解POVL的风险因素 为了开发手段，以防止这些盲人并发症。 这里还有一个独特的机会来研究围手术期的自然历史和风险因素 以及自发性眼部疾病，这是成人突然视力丧失的最常见原因之一。最多 POVL中的紧迫问题正在预测高风险个体。使用国家住院样本 JECT将检查POVL的假定风险因素，并基于这些因素构建预测风险模型 （目标1）。风险模型将使用大型商业保险数据库进行外部验证（AIM 2）。这 中心假设是，特定患者因素和特定的手术因素的存在可以预测 患POVL的风险。 AIM 1将研究危险因素并开发脊柱围手术期视觉丧失（POVL）的预测模型 使用NIS进行融合和心脏手术，并根据文献和 初步数据： 1）围手术期RAO和离子与视网膜和/或视神经的预先存在异常有关； 2）颈动脉狭窄和中风的特定形式增加了POVL的风险； 3）特定的手术因素是相关的 用POVL（包括瓣膜心脏手术）和脊柱手术中的融合程度； 4）女性性含义 - c降低了POVL的风险。 AIM 2将使用optum从AIM 1验证AIM 1的预测模型。我们将检验假设 患者特异性和手术因素的组合在定义风险水平方面具有协同作用，因此 POVL事件的摩擦性是可以预测的。 该研究符合该RFA的具体目标，用于对现有数据进行2O分析以产生新的假设。 创新包括：1）与POVL有关的现有眼科疾病有关的新概念，2）使用诊断 和程序数据以及构建风险概况指数的统计建模，以及3）与另一个的交叉验证 数据库。除了确定风险因素和风险模型的直接临床相关性外， 两者的翻译意义是导致外科患者护理的变化的可能性很大，并且 制定预防策略。根本的研究意义是研究将设定 基础工作使田间垂直发展成为伤害机制。