• Kenji Yoshitani, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Shinya Kato, Kyoko Hasuwa, Michiaki Yamakage, Yusuke Yoshikawa, Kimitoshi Nishiwaki, Kazuko Hasegawa, Yoshimi Inagaki, Kazumi Funaki, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Katsuhiro Seo, Shinichi Kakumoto, Kosuke Tsubaki, Satoshi Tanaka, Takashi Ishida, Hiroyuki Uchino, Takayasu Kakinuma, Yoshitsugu Yamada, Yoshiteru Mori, Shunsuke Izumi, Jun Shimizu, Yuko Furuichi, Nobuhide Kin, Shoichi Uezono, Kotaro Kida, Kunihiko Nishimura, Michikazu Nakai, and Yoshihiko Ohnishi.
• Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, Japan. ykenji@ncvc.go.jp.
• J Anesth. 2021 Feb 1; 35 (1): 435043-50.

BackgroundCerebrospinal 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.MethodsPatients 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.ResultsWe 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].ConclusionCSFD may not be effective for postoperative motor deficits at discharge.

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