• Annals of surgery · Aug 2023

    Diabetes Mellitus is an Independent Predictor of Spinal Cord Injury after Descending Thoracic and Thoracoabdominal Aneurysm Repair. Maximum Likelihood Conditional Regression in a Propensity-Score Matched Cohort.

    • Ivancarmine Gambardella, Berhane Worku, Christopher Lau, Robert F Tranbaugh, Sheida Tabaie, Natalia Ivascu, and Leonard N Girardi.
    • Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
    • Ann. Surg. 2023 Aug 1; 278 (2): e382e388e382-e388.

    ObjectiveTo discern the impact of diabetes mellitus (DM) on spinal cord injury (SCI) after open descending thoracic and thoracoabdominal aneurysm repair (DTAAAR).BackgroundCompared with euglycemia, hyperglycemia, and ketosis make neurons respectively more vulnerable and more resilient to ischemia.MethodsDuring the study period (1997-2021), patient who underwent DTAAAR were dichotomized according to the presence/absence of DM. The latter was investigated as predictor of our primary (SCI) and secondary [operative mortality (OM), myocardial infarction, stroke, need for tracheostomy, de novo dialysis, and survival] endpoints. Two-level risk-adjustment employed maximum likelihood conditional regression after 1:2 propensity-score matching.ResultsDTAAAR was performed in 934 patients. Ninety-two diabetics were matched to 184 nondiabetics. All preoperative variables had a standardized mean difference <0.1 between the matched groups. Patients with DM had higher SCI (6.5% vs. 1.6%, P 0.03) and OM (14.1% vs. 6.0%, P =0.01), while the other secondary endpoints were similar between groups in the matched sample. DM was an independent predictor for SCI in the matched sample (odds ratio: 5.05, 95% confidence interval: 1.17-21.71). Matched patients with DM presented decreased survival at 1 (70.2% vs. 86.2%), 5 (50.4% vas 67.5%), 10 years (31.7% vs. 36.7%) ( P =0.03). The results are summarized in the graphical abstract.ConclusionDM is associated to increased OM and decreased survival, and it is an independent predictor of SCI after open DTAAAR. Strict perioperative glycemic control should be implemented, and exogenous ketones should be investigated as neuroprotective agents to reduce such adverse events.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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