Kenji Yoshitani1, Masahiko Kawaguchi2, Mikito Kawamata3, Manabu Kakinohana4, Shinya Kato5, Kyoko Hasuwa5, Michiaki Yamakage6, Yusuke Yoshikawa6, Kimitoshi Nishiwaki7, Kazuko Hasegawa7, Yoshimi Inagaki8, Kazumi Funaki8, Mishiya Matsumoto9, Kazuyoshi Ishida9, Atsuo Yamashita9, Katsuhiro Seo10, Shinichi Kakumoto10, Kosuke Tsubaki2, Satoshi Tanaka3, Takashi Ishida3, Hiroyuki Uchino11, Takayasu Kakinuma11, Yoshitsugu Yamada12, Yoshiteru Mori12, Shunsuke Izumi4, Jun Shimizu13, Yuko Furuichi13, Nobuhide Kin14, Shoichi Uezono15, Kotaro Kida15, Kunihiko Nishimura16, Michikazu Nakai16, Yoshihiko Ohnishi5. 1. Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan. ykenji@ncvc.go.jp. 2. Department of Anesthesiology, Nara Medical University, Kashihara, Japan. 3. Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan. 4. Department of Anesthesiology, Faculty of Medicine, University of Ryukyu, Naha, Japan. 5. Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan. 6. Department of Anesthesiology, School of Medicine, Sapporo Medical University, Sapporo, Japan. 7. Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan. 8. Department of Anesthesiology and Critical Care, Medicine, Faculty of Medicine, Tottori University, Tottori, Japan. 9. Department of Anesthesiology, Graduate School of Medicine, Yamaguchi University, Ube, Japan. 10. Department of Anesthesiology and Intensive Care Medicine, Kokura Memorial Hospital, Kitakyushu, Japan. 11. Department of Anesthesiology, Tokyo Medical University, Shinjuku Ku, Japan. 12. Department of Anesthesiology, Faculty of Vital Care Medicine, The Graduate School of Medicine, The University of Tokyo, Bunkyo Ku, Japan. 13. Department of Anesthesiology, Sakakibara Heart Institute, Fuchu, Japan. 14. Department of Anesthesiology, New Tokyo Hospital, Matsudo, Japan. 15. Department of Anesthesiology, School of Medicine, The Jikei University, Minato Ku, Japan. 16. Department of Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Japan.
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.
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.
Entities:
Keywords:
Cerebrospinal fluid drainage; Motor deficits; Thoracic aortic surgery