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Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair

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Abstract

Introduction

Spinal cord ischemia is a potentially devastating complication of thoracic aortic surgery. However, predictors of outcome have not been well characterized. The study objective was to generate a prognostic score that accurately stratifies patient outcomes, aiding in future management and planning.

Methods

A retrospective review of 224 consecutive open thoracic aortic surgeries identified patients with spinal cord ischemia, defined as changes on intraoperative somatosensory evoked potentials (SSEP) and/or paraparesis/paraplegia postoperatively. The outcome of interest was poor outcome, defined as death or discharge with a lower extremity motor score ≤40, indicating impaired ambulation. Demographic and clinical characteristics were tested in univariate analyses and significant factors were incorporated in multivariate modeling to determine independent predictors of poor outcome.

Results

Seventy-five patients were identified with spinal cord ischemia, of which 43(57 %) had poor outcomes including 28(37 %) that died prior to discharge. Factors associated with poor outcome in univariate analysis included absent lumbar CSF drain (p = 0.03), surgical repair that crossed the diaphragm (p = 0.002), permanent intraoperative SSEP change (p = 0.02), postoperative renal failure (p = 0.004), paraplegia (p = 0.001), and concomitant stroke (p = 0.04). In multivariable analysis, surgical repair crossing the diaphragm (OR 4.8, CI 1.4–16.7, p = 0.02), paraplegia (OR 4.5, CI 1.4–14.0, p = 0.01), and renal failure (OR 6.1, CI 1.7–21.2, p = 0.005) were independently associated with poor outcome. Patients with transient intraoperative neurophysiologic changes were least likely to have poor outcome when compared to patients with no or permanent SSEP changes, and those not monitored (p = 0.03).

Conclusion

Development of spinal cord ischemia with thoracic aortic repair often leads to death or disability. Characteristics known at the time of event can accurately predict the likelihood of poor outcome.

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Disclosure

Dr. Becker, Ms. Rojvirat, and Dr. Bavaria report no disclosures. Dr. McGarvey receives author royalty payments from Up to Date for chapters written of spinal cord ischemia and complications of cardiac surgery for about 2,000 dollars a year. Dr. Messé reports royalties from publishing (Antiplatelet therapy for secondary stroke prevention, treatment of atrial septal abnormalities for prevention of stroke in adults, Up To Date, 2009–2012), honoraria for speaking engagements (Boehringer Ingelheim, 2009–2011), and research support (NIH U01-DK060990, stroke endpoint adjudication committee, 2009–2012; NIH U01 NS40406-04, local PI, 2009–2012; NIH 1R01HL084375-01A2, stroke endpoint adjudication committee, 2009–2012; AHA Beginning-Grant-In-Aid, PI, 2009; Gore REDUCE helex PFO closure study, local PI, 2009–2012).

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Authors and Affiliations

  1. Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, Philadelphia, PA, 19104, USA

    Danielle A. Becker, Michael L. McGarvey, Catherine Rojvirat & Steven R. Messé

  2. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Joseph E. Bavaria

Authors
  1. Danielle A. Becker
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  2. Michael L. McGarvey
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  3. Catherine Rojvirat
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  4. Joseph E. Bavaria
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  5. Steven R. Messé
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Correspondence to Danielle A. Becker.

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Becker, D.A., McGarvey, M.L., Rojvirat, C. et al. Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair. Neurocrit Care 18, 70–74 (2013). https://doi.org/10.1007/s12028-012-9807-9

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  • DOI: https://doi.org/10.1007/s12028-012-9807-9

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