Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair
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ORIGINAL ARTICLE
Cerebrospinal fluid drainage to prevent postoperative spinal cord injury in thoracic aortic repair Kenji Yoshitani1 · Masahiko Kawaguchi2 · Mikito Kawamata3 · Manabu Kakinohana4 · Shinya Kato1 · Kyoko Hasuwa1 · Michiaki Yamakage5 · Yusuke Yoshikawa5 · Kimitoshi Nishiwaki6 · Kazuko Hasegawa6 · Yoshimi Inagaki7 · Kazumi Funaki7 · Mishiya Matsumoto8 · Kazuyoshi Ishida8 · Atsuo Yamashita8 · Katsuhiro Seo9 · Shinichi Kakumoto9 · Kosuke Tsubaki2 · Satoshi Tanaka3 · Takashi Ishida3 · Hiroyuki Uchino10 · Takayasu Kakinuma10 · Yoshitsugu Yamada11 · Yoshiteru Mori11 · Shunsuke Izumi4 · Jun Shimizu12 · Yuko Furuichi12 · Nobuhide Kin13 · Shoichi Uezono14 · Kotaro Kida14 · Kunihiko Nishimura15 · Michikazu Nakai15 · Yoshihiko Ohnishi1 Received: 14 August 2020 / Accepted: 15 September 2020 © Japanese Society of Anesthesiologists 2020
Abstract 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. Keywords Thoracic aortic surgery · Cerebrospinal fluid drainage · Motor deficits
Introduction Cerebrospinal fluid drainage (CSFD) is recommended as a spinal cord protective strategy during open and endovascular thoracic aortic repair [1]. However, systematic reviews and meta-analyses found that CSFD decreased the risk of spinal cord injury (SCI), those studies do not suggest the definitive recommendation of use of CSFD [2, 3]. Furthermore, another systematic review suggested that a large-scale study
* Kenji Yoshitani [email protected] Extended author information available o
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