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  • Perioperative Retinal Artery Occlusion: Risk Factors in Cardiac Surgery

    By Marianne Doran and selected by George B. Bartley, MD
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    Journal Highlights

    Ophthalmology, February 2017

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    Calway et al. examined the incidence of and risk factors for perioperative retinal artery occlusion (RAO) in cardiac sur­gery. The authors found that the odds ratio (OR) for RAO was increased in the presence of cardiovascular risk fac­tors including stroke, carotid stenosis, and hypercoagulability, as well as pro­cedures in which the heart is opened, such as septal repair.

    In this study, the authors reviewed hospital discharges in the U.S. Nation­al Inpatient Sample (NIS) to identify cardiac surgery. RAO in the periopera­tive period was ascertained by ICD-9-CM codes. Postulated risk factors were based on a literature review and includ­ed in multivariate logistic models.

    An estimated 5,872,833 cardiac surgeries were performed in the United States from 1998 to 2013. The authors found that the overall rate of perioper­ative RAO incidence was 7.7 per 10,000 cardiac surgery procedures in this period. The conditions most strongly associated with RAO were giant cell arteritis (OR, 7.7), transient cerebral ischemia (OR, 7.67), carotid artery stenosis (OR, 7.52), embolic stroke (OR, 4.43), hypercoagulable state (OR, 2.9), diabetes mellitus (DM) with oph­thalmic complications (OR, 1.89), and aortic insufficiency (OR, 1.85). Postop­erative bleeding and surgeries in which the heart is opened (e.g., valve replacement or septal surgery) also increased the odds of RAO (range, 1.58-2.16).

    Lower odds of RAO were associ­ated with female gender, thrombo­cytopenia, acute coronary syndrome, atrial fibrillation, congestive heart failure, uncomplicated DM type 2, and smoking, although the reasons are unclear.

    The authors noted that this retro­spective review demonstrates associa­tions, not cause and effect. Neverthe­less, they suggested that their findings could help identify patients at higher risk of RAO and thus be useful in ob­taining a proper informed consent and, potentially, in altering the surgical plan.

    The original article can be found here.