Donald MacElroy, BS: No financial relationships to disclose
Introduction: Legally-blind individuals are a vulnerable population at increased risk of mechanical falls and repetitive spinal traumas, which may ultimately necessitate spinal fusion surgery. There is a paucity of studies investigating the specific considerations of spine surgeons in delivering the highest quality of care to this under-represented population. This study aims to examine patient characteristics, treatment complications, and clinical outcomes of spinal fusion surgery in legally-blind patients.
Methods: The National Inpatient Sample (NIS) was queried from 2016-2020 using International Classification of Diseases (10th Edition) for patients undergoing spinal fusion surgery. Patients with legally-blind status were further stratified through ICD-10 diagnosis codes. Furthermore, 1:1 propensity score matching (PSM) was performed to control for age, sex, race, obesity, diabetes, and smoking status. Patient characteristics, treatment complications, and clinical outcomes were evaluated for legally blind versus non-blind patients undergoing lumbar spinal fusion surgery. Statistical analyses were performed using Statistical Product and Service Solutions (SPSS, V. 29).
Results: Of the total 814,635 lumbar spinal fusion patients, 830 were classified as legally-blind. Following PSM, 530 legally-blind patients were matched to 530 non-blind patients. Legally-blind patients were significantly more likely to have a history of hardware failure (OR: 3.06, 95% CI: 1.10, 8.48), require RBC transfusion (OR: 2.18, 95% CI: 1.46, 3.25), more likely to experience postoperative delirium (OR: 3.06, 95% CI: 1.10, 8.48), less likely to have routine discharge (OR: 0.57, 95% CI: 0.44, 0.72), and more likely to be transferred to a skilled nursing facility (OR: 1.72, 95% CI: 1.32, 2.24), compared to controls.
Conclusion : Legally-blind patients undergoing lumbar spinal fusion demonstrated increased perioperative complications and decreased likelihood of routine discharge home, compared to the non-blind patients. Furthermore, significant findings regarding blood transfusion and hardware failure may be related to increased incidence of fall-related musculoskeletal injury and subsequently increased complexity of surgery. Our findings emphasize the importance of surgeon awareness in the complexities of providing high quality care to patients with a diagnosis of legal blindness.