Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair

• Published in: Journal of anesthesia Vol. 35; no. 1; pp. 43 - 50
• Main Authors: Yoshitani, Kenji, Kawaguchi, Masahiko, Kawamata, Mikito, Kakinohana, Manabu, Kato, Shinya, Hasuwa, Kyoko, Yamakage, Michiaki, Yoshikawa, Yusuke, Nishiwaki, Kimitoshi, Hasegawa, Kazuko, Inagaki, Yoshimi, Funaki, Kazumi, Matsumoto, Mishiya, Ishida, Kazuyoshi, Yamashita, Atsuo, Seo, Katsuhiro, Kakumoto, Shinichi, Tsubaki, Kosuke, Tanaka, Satoshi, Ishida, Takashi, Uchino, Hiroyuki, Kakinuma, Takayasu, Yamada, Yoshitsugu, Mori, Yoshiteru, Izumi, Shunsuke, Shimizu, Jun, Furuichi, Yuko, Kin, Nobuhide, Uezono, Shoichi, Kida, Kotaro, Nishimura, Kunihiko, Nakai, Michikazu, Ohnishi, Yoshihiko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-02-2021; Springer
• Subjects: Anesthesiology; Aneurysms; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic - surgery; Cerebrospinal Fluid; Cerebrospinal Fluid Leak; Critical Care Medicine; Drainage; Emergency Medicine; Hospitals; Humans; Intensive; Japan; Medical records; Medicine; Medicine & Public Health; Original Article; Pain Medicine; Prevention; Retrospective Studies; Spinal Cord; Spinal cord injuries; Spinal Cord Injuries - prevention & control; Spinal Cord Ischemia - etiology; Spinal Cord Ischemia - prevention & control; Japan; Thoracic aortic surgery; Cerebrospinal fluid drainage; Motor deficits
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-020-02857-w

Background
Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy in open and endovascular thoracic aortic repair. Although small studies support the use of CSFD, systematic reviews have not suggested definite conclusion and a large-scale study is needed. Therefore, we reviewed medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open and endovascular repair) at multiple institutions to assess the association between CSFD and postoperative motor deficits.
Methods
Patients included in this study underwent descending or thoracoabdominal aortic repair between 2000 and 2013 at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery. We conducted a retrospective study to investigate whether motor-evoked potential monitoring is effective in reducing motor deficits in thoracic aortic aneurysm repair. We use the same dataset to examine whether CSFD reduces motor deficits after propensity score matching.
Results
We reviewed data from 1214 patients [open surgery, 601 (49.5%); endovascular repair, 613 (50.5%)]. CSFD was performed in 417 patients and not performed in the remaining 797 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. After propensity score matching (
n
 = 700), mixed-effects logistic regression performed revealed that CSFD is associated with postoperative motor deficits at discharge [adjusted odds ratio (OR), 3.87; 95% confidence interval (CI), 2.30–6.51].
Conclusion
CSFD may not be effective for postoperative motor deficits at discharge.