Incidence and risk factors of postoperative visual loss in cardiac surgery in the United States from the national inpatient sample 2013 to 2022

Postoperative Visual Loss (POVL), a rare but severe complication, occurs more often in cardiac surgery. It leads to significant disability, emotional distress, and healthcare costs. In the U.S., where cardiac surgery is common, POVL is challenging to treat, thus identifying characteristics associated with POVL is key to identifying at-risk patients. Uncovering risk factors and prevention strategies for this serious event is crucial. This study aims to assess incidence trends and correlate patient and perioperative factors with POVL. A retrospective study was conducted using the National Inpatient Sample (NIS) database from 2013 to 2022, the largest fully paid hospital care database in the United States. The patient’s demographics, hospital characteristics, length of stay (LOS), total costs, in-hospital mortality, preoperative comorbidities, and postoperative complications were documented. Logistic regression analysis was performed to identify the risk factors and associated factors of POVL. A total of 544,757 patients who underwent cardiac surgery were identified from the NIS database between the period of 2013 and 2022. The incidence of POVL was 1 in 1000 surgeries, or 0.10%, with no significant linear upward or downward trend. Patients with POVL after cardiac surgery presented prolonged LOS and increased hospitalization costs. Preoperative risk factors associated with postoperative POVL included the 18–49 age group, admission to a teaching hospital, anemia, paralysis, peripheral vascular disorders, valvular disease, and weight loss. Additionally, POVL was also associated with in-hospital complications including blood transfusion, acute renal failure, pulmonary embolism, stroke, and arrhythmia. Conversely, the protective factors included black, Hispanic, Asian, and Pacific Islander ethnicity, elective hospital admissions, the south region of the hospital, and hypertension. This nationwide study identified a relatively low incidence of POVL after cardiac surgery and shows no significant trend. In the absence of effective treatment, it is crucial to identify high-risk patients, implement well-planned anesthetic management, and conduct postoperative vision assessments to prevent visual loss.