Kenji Yoshitani1, Kenichi Masui2,3, Masahiko Kawaguchi4, Mikito Kawamata5, Manabu Kakinohana6, Shinya Kato1, Kyoko Hasuwa1, Michiaki Yamakage7, Yusuke Yoshikawa7, Kimitoshi Nishiwaki8, Tadashi Aoyama8, Yoshimi Inagaki9, Kazumasa Yamasaki9, Mishiya Matsumoto10, Kazuyoshi Ishida10, Atsuo Yamashita10, Katsuhiro Seo11, Shinichi Kakumoto11, Hironobu Hayashi4, Yuu Tanaka4, Satoshi Tanaka5, Takashi Ishida5, Hiroyuki Uchino12, Takayasu Kakinuma12, Yoshitsugu Yamada13, Yoshiteru Mori13, Shunsuke Izumi6, Kunihiro Nishimura14, Michikazu Nakai14, Yoshihiko Ohnishi1. 1. From the Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan. 2. Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan. 3. Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan. 4. Department of Anesthesiology, Nara Medical University, Kashihara, Japan. 5. Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan. 6. Department of Anesthesiology, University of Ryukyu, Faculty of Medicine, Nishihara, Japan. 7. Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan. 8. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Chikusa-ku, Nagoya. 9. Department of Anesthesiology and Critical Care and Medicine, Tottori University, Faculty of Medicine, Tottori, Japan. 10. Department of Anesthesiology, Yamaguchi University, Graduate School of Medicine, Ube, Japan. 11. Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan. 12. Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan. 13. Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 14. Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan.
Abstract
BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69-1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10-11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32-3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27-0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%-49.5%) and 95.5% (95% CI, 94.7%-96.4%), respectively. CONCLUSIONS: MEP monitoring was not significantly associated with motor deficits at discharge.
BACKGROUND:Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS:Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69-1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10-11.91; P < .001), spinal drainage (adjusted OR, 2.14; 95% CI, 1.32-3.47; P = .002), and endovascular procedure (adjusted OR, 0.45; 95% CI, 0.27-0.76; P = .003). The sensitivity and specificity of MEP <25% of control value for motor deficits at discharge were 37.8% (95% CI, 26.5%-49.5%) and 95.5% (95% CI, 94.7%-96.4%), respectively. CONCLUSIONS:MEP monitoring was not significantly associated with motor deficits at discharge.
Authors: David R Busch; Wei Lin; Chia Chieh Goh; Feng Gao; Nicholas Larson; Joseph Wahl; Thomas V Bilfinger; Arjun G Yodh; Thomas F Floyd Journal: PLoS One Date: 2021-05-10 Impact factor: 3.240