naa a22 4500 510800009 CHVBK 20180411083351.0 cr unu---uuuuu 180411e20130201xx s 000 0 eng 10.1007/s12028-012-9807-9 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9807-9 Predictors of Outcome in Patients with Spinal Cord Ischemia after Open Aortic Repair [Elektronische Daten] [Danielle Becker, Michael McGarvey, Catherine Rojvirat, Joseph Bavaria, Steven Messé] 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. Springer Science+Business Media New York, 2012 Aortic dissection nationallicence Thoracic aorta nationallicence Spinal cord ischemia nationallicence Somatosensory evoked potentials (SSEP) nationallicence Stroke nationallicence Outcome nationallicence Becker Danielle Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut McGarvey Michael Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut Rojvirat Catherine Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut Bavaria Joseph Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA aut Messé Steven Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut Neurocritical Care Humana Press Inc 18/1(2013-02-01), 70-74 1541-6933 18:1<70 2013 18 12028 https://doi.org/10.1007/s12028-012-9807-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9807-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Becker Danielle Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- McGarvey Michael Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Rojvirat Catherine Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Bavaria Joseph Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Messé Steven Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 West Gates Building, 19104, Philadelphia, PA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/1(2013-02-01), 70-74 1541-6933 18:1<70 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer