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