Previous Abstract | Next Abstract
Printable Version
A1173
October 16, 2012
8:00:00 AM - 11:00:00 AM
Room Hall C-Area C
Perioperative Visual Injury in Radical Prostatectomy: A 10 Year Study From 2000-2009
Ajay Sampat, M.D., David Glick, M.D., Steven Roth, M.D.
University of Chicago, Chicago, Illinois, United States
Background:

Perioperative visual injury (POVI) accompanying non-occular surgeries has been characterized in several different types of operations, but not in prostatectomy. Anecdotal reports suggest the occurence of injuries to the visual system in either open (OP) or robotic assisted radical prostatectomy (RAP), with suspicion that they are more likely in RAP, perhaps due to length of surgery or patient positioning. Our study compares POVI in RAP to that in OP. Many studies have demonstrated the benefit of RAP in reducing the incidence of post-op infection, transfusion requirement, and duration of hospital stay (1). To date, a small single institution study suggested an increase in corneal abrasion in RAP vs. OP (2). Our study used a national database to compare the incidence of POVI in RAP and OP, and to characterize the trend of POVI in prostatectomy over the last 10 years.

Methods:

Data disks from the Nationwide Inpatient Sample (NIS) were obtained for the years 2000-2009. Patients who underwent radical prostatectomy and had the corresponding ICD9 procedure code (60.5) were abstracted for each year. ICD9 diagnostic codes for common causes of POVI were searched in each database and the incidence rates of each were tabulated for each year (Table 1). For 2009, the robot-assisted modifier code (17.42) was used to identify RAP cases, which were examined separately from the OP cases. Of note, the 17.42 code was not used prior to 2009. Incidence of POVI was compared to a control group, laparoscopic cholecystectomy.

Results:

A total of 136,711 cases of radical prostatectomy were in the NIS over the 10 year period from 2000-2009. Of these cases, the overall incidence of POVI was 0.22%, and that of corneal abrasions was 0.15% (Table 2). There was an overall increasing trend in the total rate of POVI and of corneal abrasion during the 10-year period when compared with the control (Figure 1). In 2009, of the 15,614 radical prostatectomies, 39.7% were OP, while 60.3% were RAP. Rates of occular injury were significantly increased in the robotic group vs. the open approach group for both total POVI (OR=2.924, 95% CI 1.561-5.475, p=0.0004), as well as for corneal abrasion (OR=2.792, 95% CI 1.349-5.777, p=0.004).

Conclusion:

Rates of POVI, and of corneal abrasion in particular, have increased nearly 10-fold over the span from 2000-2009. This corresponds to the time period where the robotic approach became the predominant method of performing radical prostatectomies (3). The data from 2009 showed a higher rate of POVI, specifically of corneal abrasion, when the robotic approach is used compared to the open approach. Clinicians should be vigilant and methods should be developed to lower the incidence of these eye injuries.

1) JAMA. Oct 14;302(14):1557-64, 2009.

2) J Robotic Surg. 1:119-123, 2007.

3) Eur Urol. Apr;61(4):803-9, 2012.
Figure 1
Figure 2
Figure 3

Copyright © 2012 American Society of Anesthesiologists