1
|
Sperber J, Owolo E, Zachem TJ, Bishop B, Johnson E, Lad EM, Goodwin CR. Perioperative Blindness in Spine Surgery: A Scoping Literature Review. J Clin Med 2024; 13:1051. [PMID: 38398364 PMCID: PMC10889585 DOI: 10.3390/jcm13041051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Perioperative vision loss (POVL) is a devastating surgical complication that impacts both the recovery from surgery and quality of life, most commonly occurring after spine surgery. With rates of spine surgery dramatically increasing, the prevalence of POVL will increase proportionately. This scoping review aims to aggregate the literature pertinent to POVL in spine surgery and consolidate recommendations and preventative measures to reduce the risk of POVL. There are several causes of POVL, and the main contribution following spine surgery is ischemic optic neuropathy (ION). Vision loss often manifests immediately following surgery and is irreversible and severe. Diffusion weighted imaging has recently surfaced as a diagnostic tool to identify ION. There are no effective treatments; therefore, risk stratification for counseling and prevention are vital. Patients undergoing prone surgery of long duration and/or with significant expected blood loss are at greatest risk. Future research is necessary to develop effective treatments.
Collapse
Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
| | - Tanner J. Zachem
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA
| | - Brandon Bishop
- College of Medicine, Kansas City University; Kansas City, MO 64106, USA
| | - Eli Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
| | - Eleonora M. Lad
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA
| | - C. Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
2
|
Pitsika M, Paschou VM, Pollard R, Nissen JJ. Perioperative visual loss and consent for adult spine surgery: a national survey of the practice amongst spine surgeons and anaesthetists †. Br J Neurosurg 2023:1-8. [PMID: 37943103 DOI: 10.1080/02688697.2023.2275621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Perioperative Visual Loss (POVL) is a devastating complication for patients undergoing spine surgery. Consent process for POVL amongst spine surgeons and anaesthetist remains variable. The aim of this study is to evaluate their practice and views about it. METHODS Two similar questionnaires were distributed to members of the Society of British Neurological Surgeons (SBNS), British Association of Spine Surgeons (BASS), and Neuroanaesthsia and Critical Care Society (NACCS). RESULTS A total of 271 responses were received (SBNS/BASS n = 149, NACCS n = 122). Fewer surgeons considered POVL as a material risk for patients compared to the anaesthetists (57.7 versus 79.7%). Outpatient/pre-assessment clinics were considered as the optimal setting for discussing POVL by the majority of the clinicians (81.2 and 93.4%). POVL should be discussed by both specialists according to 75% of the anaesthetists. Estimated incidence of POVL was considered to be higher by the anaesthetists (0.03-0.2% by 63% of the anaesthetist versus 0.0001-0.004% by 57% of the surgeons). Twenty-three surgeons and 10 anaesthetists had a patient who suffered from POVL, which led to a change of practice in most of them. This questionnaire will lead to a change in practice/consent to 18.1% of the surgeons and 23.5% of the anaesthetists. CONCLUSIONS Most of the surgeons and anaesthetist feel that POVL is a material risk that ideally needs to be firstly discussed before the day of surgery, by both specialties. However, a significant number of clinicians have an opposite view. A national guidance from respective societies should encourage POVL to be discussed routinely.
Collapse
Affiliation(s)
- Marina Pitsika
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | | | - Rachel Pollard
- Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Justin J Nissen
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| |
Collapse
|
3
|
Shah SH, Xiao L, Chen YF, Moss HE, Rubin DS, Roth S. Perioperative Ischemic Optic Neuropathy after Cardiac Surgery: Development and Validation of a Preoperative Risk Prediction Model. J Cardiothorac Vasc Anesth 2022; 36:4266-4272. [PMID: 36114093 PMCID: PMC10874298 DOI: 10.1053/j.jvca.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies identified risk factors for ischemic optic neuropathy (ION) after cardiac surgery; however, there is no easy-to-use risk calculator for the physician to identify high-risk patients for ION before cardiac surgery. The authors sought to develop and validate a simple-to-use predictive model and calculator to assist with preoperative identification of risk and informed consent for this rare but serious complication. DESIGN Retrospective case-control study. SETTING Hospital discharge records. PATIENTS A total of 5,561,177 discharges in the National Inpatient Sample >18 years of age, with procedure codes for coronary artery bypass grafting, heart valve repair/replacement, or left ventricular assist device insertion. INTERVENTIONS All patients had undergone cardiac surgery. MEASUREMENTS AND MAIN RESULTS Known preoperative risk factors for ION after cardiac surgery were assessed to develop a risk score and prediction model. This model was validated internally using the split-sample method. There were 771 cases of ION among 5,561,177 patients in the National Inpatient Sample. The risk factors for ION used in the model were carotid artery stenosis, cataract, diabetic retinopathy, macular degeneration, glaucoma, male sex, and prior stroke; whereas uncomplicated diabetes decreased risk. With the internal validation, the predictive model had an area under the receiver operating characteristic curve of 0.66. A risk score cutoff ≥3 had 98.4% specificity. CONCLUSIONS This predictive model, based on previously identified preoperative factors, predicted risk of perioperative ION with a fair area under the receiver operating characteristic curve. This predictive model could enable screening to provide a more accurate risk assessment for ION, and consent process for cardiac surgery.
Collapse
Affiliation(s)
- Shikhar H Shah
- Department of Anesthesiology, Walter Reed National Military Medical Center, Washington, DC
| | - Lan Xiao
- Center for Community Engagement, Stanford University, Stanford, CA
| | - Yi-Fan Chen
- The Center for Clinical & Translational Sciences, University of Illinois at Chicago, Chicago, IL
| | - Heather E Moss
- Departments of Ophthalmology and Neurology and Neurologic Sciences, Stanford University, Stanford, CA
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago College of Medicine, Chicago, IL; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine, Chicago, IL.
| |
Collapse
|
4
|
Roth S, Moss HE, Vajaranant TS, Sweitzer B. Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery. Anesthesiology 2022; 137:620-643. [PMID: 36179149 PMCID: PMC9588701 DOI: 10.1097/aln.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.
Collapse
Affiliation(s)
- Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurologic Sciences, Stanford University, Palo Alto, California
| | - Thasarat Sutabutr Vajaranant
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - BobbieJean Sweitzer
- University of Virginia, Charlottesville, Virginia; Perioperative Medicine, Inova Health System, Falls Church, Virginia
| |
Collapse
|
5
|
Moss HE, Xiao L, Shah SH, Chen YF, Joslin CE, Roth S. Predictive model of ischemic optic neuropathy in spinal fusion surgery using a longitudinal medical claims database. Spine J 2021; 21:377-386. [PMID: 33248270 PMCID: PMC7887045 DOI: 10.1016/j.spinee.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/22/2020] [Accepted: 11/19/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Perioperative ischemic optic neuropathy (ION) is a devastating complication of spinal fusion surgery. PURPOSE To develop predictive models of this blinding condition using a longitudinal medical administrative claims database, which provides temporal sequence of perioperative ischemic optic neuropathy and potential risk factors. DESIGN Nested case control study. PATIENT SAMPLE Participants in Cliniformatics Data Mart medical claims database (2007-2017) with hospitalization involving lumbar or thoracic spinal fusion surgery and no history of ION. OUTCOME MEASURES Perioperative ION (or not) during hospitalization for lumbar or thoracic spinal fusion surgery. METHODS Sixty-five ION cases and 106,871 controls were identified. Matched controls (n=211) were selected based on year of surgery and zip code. Chronic and perioperative variables were assigned based on medical claims codes. Least absolute shrinkage and selection (LASSO) penalized conditional logistic regression with 10-fold cross validation was used to select variables for the optimal predictive model from the subset of variables with p<.15 between cases and matched controls (unadjusted conditional logistic regression). Receiver operating characteristic (ROC) curves were generated for the strata-independent matched and full sample. RESULTS The predictive model included age 57-65 years, male gender, diabetes with and without complications, chronic anemia, hypertension, heart failure, carotid stenosis, perioperative hemorrhage and perioperative organ damage. Area under ROC curve was 0.75 (95% confidence interval [CI]: 0.68, 0.82) for the matched sample and 0.72 (95% CI: 0.66, 0.78) for the full sample. CONCLUSIONS This predictive model for ION in spine fusion considering chronic conditions and perioperative conditions is unique to date in its use of longitudinal medical claims data, inclusion of International Classification of Disease-10 codes and study of ophthalmic conditions as risk factors. Similar to other studies of this condition the multivariable model included age, male gender, perioperative organ damage and perioperative hemorrhage. Hypertension, chronic anemia and carotid artery stenosis were new predictive factors identified by this study.
Collapse
Affiliation(s)
- Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA; Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA.
| | - Lan Xiao
- Center for Population Health Sciences, Stanford University, Stanford, CA
| | - Shikhar H Shah
- Department of Anesthesiology, Walter Reed Military Medical Center, Bethesda, MD, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Sciences, University of Illinois, Chicago, IL, USA
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Steven Roth
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
| |
Collapse
|
6
|
Jones XM, Zimba O, Gupta L. Informed Consent for Scholarly Articles during the COVID-19 Pandemic. J Korean Med Sci 2021; 36:e31. [PMID: 33463097 PMCID: PMC7813582 DOI: 10.3346/jkms.2021.36.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022] Open
Abstract
The coronavirus disease 2019 pandemic has caused a breakdown in the healthcare system worldwide. The need to rapidly update guidelines in order to control the transmission in the population and for evidenced-based healthcare care has led to the need for timely, voluminous and valid research. Amid the quest for a vaccine and better therapies, researchers clamouring for information has led to a wide variety of ethical issues due to the unique situation. This paper aims to examine the positive and negative aspects of recent changes in the process of obtaining informed consent. The article outlines the various aspects, from history, previously described exemptions to consenting as well as those implemented during the pandemic and the current impact of virtual methods. Further, the authors make recommendations based on the outcome of suggested adjustments described in the literature. This article looks into increasing the awareness of physicians and researchers about ethical issues that need to be addressed to provide optimal care for patients while assuring their integrity and confidentiality.
Collapse
Affiliation(s)
| | - Olena Zimba
- Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Latika Gupta
- Department Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| |
Collapse
|
7
|
Shah SH, Chen YF, Moss HE, Rubin DS, Joslin CE, Roth S. Predicting Risk of Perioperative Ischemic Optic Neuropathy in Spine Fusion Surgery: A Cohort Study Using the National Inpatient Sample. Anesth Analg 2020; 130:967-974. [PMID: 31490255 PMCID: PMC8098669 DOI: 10.1213/ane.0000000000004383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ischemic optic neuropathy (ION) is a rare complication of anesthesia and surgery that causes vision loss in spine fusion. We sought to develop a predictive model based on known preoperative risk factors for perioperative ION to guide patient and physician preoperative decision-making. METHODS In the National Inpatient Sample (NIS) for 1998-2012, discharges for posterior thoracic, lumbar, and sacral spine fusion were identified and classified by ION status. Variables were selected without weighting via variable clustering using Principal Component Analysis of Mixed Data (PCA-MIX). Hierarchical clustering with 4 clusters was performed, and the variable with largest squared loading in each cluster was chosen. By splitting our sample into a training and testing data set, we developed and internally validated a predictive model. The final model using variables known preoperatively was constructed to allow determination of relative and absolute risk of developing perioperative ION and was tested for calibration and discrimination. RESULTS The final predictive model based on hierarchical clustering contained 3 preoperative factors, age, male or female sex, and the presence of obstructive sleep apnea (OSA). The predictive model based on these factors had an area under the receiver operating characteristic curve (AUC) of 0.65 and good calibration. A score cutoff of >1 had 100% sensitivity, while score of 3 had 96.5% specificity. The highest estimated absolute risk (844.5/million) and relative risk of ION (46.40) was for a man, age 40-64 years, with OSA. CONCLUSIONS The predictive model could enable screening for patients at higher risk of ION to provide more accurate risk assessment and surgical and anesthetic planning for perioperative ION in spine fusion.
Collapse
Affiliation(s)
- Shikhar H Shah
- From the Department of Anesthesiology, Walter Reed National Military Medical Center, Washington, DC
| | - Yi-Fan Chen
- The Center for Clinical & Translational Sciences, University of Illinois at Chicago
| | - Heather E Moss
- Departments of Ophthalmology
- Neurology & Neurological Sciences, Stanford University, Palo Alto, California
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Department of Epidemiology and Biostatistics, College of Public Health, University of Illinois at Chicago
| | - Steven Roth
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
8
|
Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery 2019: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss, the North American Neuro-Ophthalmology Society, and the Society for Neuroscience in Anesthesiology and Critical Care. Anesthesiology 2019; 130:12-30. [PMID: 30531555 DOI: 10.1097/aln.0000000000002503] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text.
Collapse
|
9
|
Unilateral visual loss after spine surgery: Lesson to be learnt from unexpected devastating complication. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
10
|
Neurological Complications in Cardiac Surgery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00344-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
11
|
Raphael J, Moss HE, Roth S. Perioperative Visual Loss in Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:1420-1429. [PMID: 30616896 DOI: 10.1053/j.jvca.2018.11.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Jacob Raphael
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Heather E Moss
- Department of Ophthalmology and Neurology, Stanford University, Palo Alto, CA; Department of Neurological Sciences, Stanford University, Palo Alto, CA
| | - Steven Roth
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, IL; Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL.
| |
Collapse
|
12
|
Buchlak QD, Kowalczyk M, Leveque JC, Wright A, Farrokhi F. Risk stratification in deep brain stimulation surgery: Development of an algorithm to predict patient discharge disposition with 91.9% accuracy. J Clin Neurosci 2018; 57:26-32. [DOI: 10.1016/j.jocn.2018.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/12/2018] [Accepted: 08/21/2018] [Indexed: 01/25/2023]
|
13
|
Roth S, Moss HE. Update on Perioperative Ischemic Optic Neuropathy Associated With Non-ophthalmic Surgery. Front Neurol 2018; 9:557. [PMID: 30042726 PMCID: PMC6048244 DOI: 10.3389/fneur.2018.00557] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 01/16/2023] Open
Abstract
Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries. Ischemic optic neuropathy (ION), and retinal arterial occlusion (RAO) are the main causes (1, 2). Less frequent are cortical blindness (3), acute glaucoma (4), and choroidal and vitreous hemorrhage (5). ION is the most common cause for which the neurologist or neuro-ophthalmologist is consulted as it is associated either with a normal ophthalmic exam (posterior ION, PION), or less often, with optic nerve (ON) head swelling (anterior ION, AION). The presumed cause is impaired blood supply to the optic nerve (Figure 1). The most common surgical procedures complicated by ION are cardiac surgery and spinal fusion. Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative ION (poION), with cohort and case-control studies helping to identify candidate risk factors (6, 7). Animal models have provided insight regarding mechanisms (8). This mini-review is an update on the latest advancements regarding poION in non-ophthalmic surgeries in epidemiological, clinical, and animal studies.
Collapse
Affiliation(s)
- Steven Roth
- Department of Anesthesiology, and Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, United States
| |
Collapse
|
14
|
Fandino W. Strategies to prevent ischemic optic neuropathy following major spine surgery: A narrative review. J Clin Anesth 2017; 43:50-58. [DOI: 10.1016/j.jclinane.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 01/18/2023]
|
15
|
Steadman J, Catalani B, Sharp C, Cooper L. Life-threatening perioperative anesthetic complications: major issues surrounding perioperative morbidity and mortality. Trauma Surg Acute Care Open 2017; 2:e000113. [PMID: 29766107 PMCID: PMC5887586 DOI: 10.1136/tsaco-2017-000113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022] Open
Abstract
Perioperative morbidity and mortality related to anesthesia involves multiple factors. Patient characteristics and comorbidities play a role in many of these events, highlighting the importance of preoperative screening. While optimization of patient comorbidities is not always possible, having data regarding those comorbidities can prove life-saving. Equipment and medication considerations also enter into untoward outcomes such as anesthetic interventions outside of the traditional operating room where resources are sometimes lacking and haste creates errors. Ultimately, when surgeons and anesthesiologists cooperate in patient care, communicating concisely but thoroughly, patients are more likely to do well. The language of surgeons is that of diagnosis requiring a surgical intervention, while anesthesiologists are discussing patient comorbidities impacted by anesthetic medications, positive pressure ventilation, neuraxial techniques, ramifications of patient positioning, effects of opiates and so on. Because all of the considerations combine in determining outcomes, it is incumbent on both surgeons and anesthesiologists to understand those elements leading to severe morbid events as well as death. This review touches on many of the most important factors.
Collapse
Affiliation(s)
- Joy Steadman
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Blas Catalani
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christopher Sharp
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lebron Cooper
- Department of Anesthesiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
16
|
Mendel E, Stoicea N, Rao R, Niermeyer W, Revilla S, Cluse M, Sandhu G, Todaro GJ, Bergese SD. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations. Front Surg 2017; 4:34. [PMID: 28695122 PMCID: PMC5483430 DOI: 10.3389/fsurg.2017.00034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022] Open
Abstract
Postoperative vision loss (POVL) following non-ocular surgery is a serious complication where the causes are not fully understood. Studies have identified several causes of POVL as well as risk factors and prevention strategies. POVL research is made difficult by the fact that cases are often subject to malpractice claims, resulting in a lack of public access to case reports. This literature review was conducted in order to identify legal issues as a major barrier to studying POVL and address how this affects current knowledge. Informed consent provides an opportunity to overcome legal challenges by reducing malpractice litigation through educating the patient on this outcome. Providing pertinent information regarding POVL during the informed consent process has potential to reduce malpractice claims and increase available clinical information.
Collapse
Affiliation(s)
- Ehud Mendel
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rahul Rao
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - Weston Niermeyer
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephen Revilla
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Marcus Cluse
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gurneet Sandhu
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sergio D Bergese
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
17
|
Cobar-Bustamante AE, Cahueque MA, Caldera G. Visual loss after spine surgery: Case report. J Orthop 2016; 13:239-41. [PMID: 27408495 DOI: 10.1016/j.jor.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/29/2016] [Indexed: 11/29/2022] Open
Abstract
The presence of postoperative visual loss is a well-known complication, and described in various reports, its low incidence (0.028-0.2%) makes it extremely rare. Two main causes have been determined: Posterior Ischemic Optic Neuropathy and central Retinal Artery Oclusion. The following is a case report of a 52-year-old patient that presented visual loss after elective spine surgery that had no complications that could initially explain this complication. Studies were performed and evaluations by ophthalmologists determined that the cause of Posterior Ischemic Optic Neuropathy due to multiple risk factors that the patient had previously and during the surgery. After 3 year follow-up the patient still has total visual loss and no other complications were reported.
Collapse
Affiliation(s)
- Andrés E Cobar-Bustamante
- Centro Médico de Occidente Hospital, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Mario A Cahueque
- Centro Médico de Occidente Hospital, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| | - Gustavo Caldera
- Centro Médico de Occidente Hospital, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
| |
Collapse
|
18
|
Hsia IKH, Dexter F, Logvinov I, Tankosic N, Ramakrishna H, Brull SJ. Survey of the National Drug Shortage Effect on Anesthesia and Patient Safety: A Patient Perspective. Anesth Analg 2015. [PMID: 26197376 DOI: 10.1213/ane.0000000000000798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are few data on patients' desire to be informed of drug shortages before elective surgery. We surveyed patients who had previously undergone laparoscopic cholecystectomy for their opinions. METHODS Nine hundred forty-nine Mayo Clinic patients were invited to participate in the survey. The postal survey posed a hypothetical surgical scenario and requested answers regarding the desire to be informed and to postpone scheduled surgery because of neostigmine shortage. Comparison was made with Canadian patients from a hospital in Ontario. RESULTS Most of the 256 respondents wanted "to be told by the anesthesia doctor about the neostigmine shortage" if there were "slight differences" in side effects between the drug combinations (P < 0.0001). The percentage of patients wanting to know was 76.2% (95% confidence interval, 70.5%-81.3%). Secondary analyses tested the validity and reliability of the survey. With each increase in the differences in substituted drug's side effects, there was a progressive increase in the patients' desire for information (P < 0.0001; 73.2%, 76.2%, and 95.7% of 246, 256, and 253 respondents, respectively) and preference for delaying surgery (P< 0.0001; 33.6%, 39.4%, and 80.9% of 238, 246, and 241 respondents, respectively). There was no association with respondents' sex (P = 0.19), age (P = 0.76), educational level (P = 0.39), or country (United States versus Canada [n = 58]; P = 0.87). CONCLUSIONS The majority (>50%) of surveyed patients want to be informed of drug shortages that might affect their care.
Collapse
Affiliation(s)
- Ivan Kai-Hsiang Hsia
- From the *Department of Anesthesiology, Windsor Regional Hospital Ouellette Campus, Windsor, Ontario, Canada; †Division of Management Consulting, Department of Anesthesia, The University of Iowa, Iowa City, Iowa; ‡Department of Nursing, Mayo Clinic College of Medicine, Jacksonville, Florida; §Department of Anesthesiology, Mayo Clinic College of Medicine, Phoenix, Arizona; and ‖Department of Anesthesiology, Mayo Clinic College of Medicine, Jacksonville, Florida
| | | | | | | | | | | |
Collapse
|
19
|
Naderi S. Postoperative Visual Loss After Spine Surgery and the Role of the Neurosurgeon. World Neurosurg 2015; 86:54-5. [PMID: 26431728 DOI: 10.1016/j.wneu.2015.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sait Naderi
- Department of Neurosurgery, Umraniye Egitim ve Arastirma Hospital, Istanbul, Turkey.
| |
Collapse
|
20
|
Neurosurgery Tricks of the Trade. J Neurosurg Anesthesiol 2015. [DOI: 10.1097/ana.0000000000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Berlin L. Shared Decision-Making: Is It Time to Obtain Informed Consent Before Radiologic Examinations Utilizing Ionizing Radiation? Legal and Ethical Implications. J Am Coll Radiol 2014; 11:246-51. [DOI: 10.1016/j.jacr.2013.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
|
22
|
Affiliation(s)
- Michael A. Olympio
- Departments of Anesthesiology and Urology; Wake Forest School of Medicine; Winston-Salem NC USA
| |
Collapse
|
23
|
Faghanipour S, Joolaee S, Sobhani M. Surgical informed consent in Iran—how much is it informed? Nurs Ethics 2013; 21:314-22. [DOI: 10.1177/0969733013498525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Informed consent constitutes one of the most important legal, professional, and ethical principles of a surgical operation. Consent obtained from a patient is only valid when the patient has received enough information regarding the proposed treatment option. This study aims to determine how much the patients are informed before undergoing surgery, as well as the factors influencing it in hospitals affiliated with Tehran University of Medical Sciences. Method: This is a cross-sectional, descriptive–analytic study of 300 patients undergoing surgery in 7 teaching hospitals affiliated with Tehran University of Medical Sciences. The patients were recruited through clustered sampling. Data were collected using a questionnaire completed by interview. Data were analyzed on SPSS software using descriptive and inferential statistics. Result: The mean score of data provision for patients was 27.09 out of 60, indicating the level of information provided as unacceptable. Among 12 questions dealing with data provision, patients had received an intermediate level of information about nature of the disease, type of surgery, benefits and importance of the surgery, and complications of rejecting the recommended therapy. On the contrary, they had not received enough information about the surgical procedure, type of anesthesia, potential complications of surgery, potential risks of surgery, other therapy options instead of surgery, length of hospital stay for surgery, postsurgical follow-up, and expenses of the surgery. In the majority (85%) of cases, the surgeon was reported to be the information provider. Among the variables studied, level of information received was directly related to the patient’s education level. Discussion: The findings of this study indicate that during the process of obtaining an informed consent for surgery, patients do not receive sufficient information, and it is necessary to provide the essential information in an understandable manner adjusted for the patient’s level of education.
Collapse
|
24
|
Frost EAM. Essentials of Neurosurgical Anesthesia and Critical Care. Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications. J Neurosurg Anesthesiol 2012. [DOI: 10.1097/ana.0b013e3182617938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
|