Dataset Information

Analysis of Spinal Cord Infarction Associated with Aortic Stent Graft Placement Using Nationwide Inpatient Sample (2002-2011).

ABSTRACT: PURPOSE:We performed this study to identify the rate and determinants of and associated outcomes with spinal cord infarction among patients treated with aortic stent graft placement at a national level. METHODS:We analyzed the data files from Nationwide Inpatient Sample (NIS) from 2002 to 2011. We performed multivariate logistic regression analysis to assess the rates of moderate to severe disability or death in patients with and without spinal cord infarction after adjusting for age, gender, and comorbidities that were significant in univariate analysis. We also determined change in annual rates of spinal cord infarction associated with aortic stent graft placement from 2002 through 2011. RESULTS:Spinal cord infarction occurred in 761 (0.2%) of 305,788 patients who underwent aortic stent graft placement. There was an increase in the annual rate of spinal cord infarction among patients who underwent aortic stent graft placement from 2002 (0.03%) to 2011 (0.4%) (p <0.001). The patients who developed spinal cord infarction had significantly higher odds of in hospital mortality ([odd ratio] OR: 3.0; 95% confidence interval [CI]: 2.4-3.8) after adjusting for age, gender, race/ethnicity, aortic aneurysms, thoracic graft, hypertension, ischemic strokes or transient ischemic attacks, coagulopathy, congestive heart failure, deficiency or chronic blood loss anemia, atrial fibrillation, renal failure, elective admission, and teaching hospital status. Among those who were discharged alive, patients who developed spinal cord infarction had significantly higher odds of moderate to severe disability (OR: 2.8; 95% CI: 2.5-3.2). CONCLUSIONS:The occurrence of spinal cord infarction in patients undergoing aortic stent graft placement appears to be increasing. Spinal cord infarction is associated with prominently higher rates of death and moderate to severe disability.

SUBMITTER: Qureshi AI

PROVIDER: S-EPMC4762405 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Analysis of Spinal Cord Infarction Associated with Aortic Stent Graft Placement Using Nationwide Inpatient Sample (2002-2011).

Qureshi Adnan I AI Chughtai Morad M Malik Ahmed A AA

Journal of vascular and interventional neurology 20160101 5

<h4>Purpose</h4>We performed this study to identify the rate and determinants of and associated outcomes with spinal cord infarction among patients treated with aortic stent graft placement at a national level.<h4>Methods</h4>We analyzed the data files from Nationwide Inpatient Sample (NIS) from 2002 to 2011. We performed multivariate logistic regression analysis to assess the rates of moderate to severe disability or death in patients with and without spinal cord infarction after adjusting for ...[more]

PMID: 26958147

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Project description:BackgroundSimultaneous treatment of multilevel aortic disease is controversial due to the theoretic increase in morbidity. This study was conducted to define the outcomes in patients treated electively with simultaneous thoracic endovascular aortic aneurysm repair (TEVAR) and abdominal aortic endovascular endografting for synchronous aortic pathology.MethodsPatients treated with simultaneous TEVAR and endovascular aneurysm repair (T&E) at the University of Florida were identified from a prospectively maintained endovascular aortic registry and compared with those treated with TEVAR alone (TA). The study excluded patients with urgent or emergency indications, thoracoabdominal or mycotic aneurysm, and those requiring chimney stents, fenestrations, or visceral debranching procedures. Demographics, anatomic characteristics, operative details, and periprocedural morbidity were recorded. Mortality and reintervention were estimated using life-table analysis.ResultsFrom 2001 to 2011, 595 patients underwent TEVAR, of whom 457 had elective repair. Twenty-two (18 men, 82%) were identified who were treated electively with simultaneous T&E. Mean ± standard deviation age was 66 ± 9 years, and median follow-up was 8.8 months (range, 1-34 months). Operative indications for the procedure included dissection-related pathology in 10 (45%) and various combinations of degenerative etiologies in 12 (55%). Compared with TA, T&E patients had significantly higher blood loss (P < .0001), contrast exposure (P < .0001), fluoroscopy time (P < .0001), and operative time (P < .0001). The temporary spinal cord ischemia rate was 13.6% (n = 3) for the T&E group and 6.0% for TA (P = .15); however, the permanent spinal cord ischemia rate was 4% for both groups (P = .96). The 30-day mortality for T&E was 4.5% (n = 1) compared with 2.1% (n = 10) for TA. Temporary renal injury (defined by a 25% increase over baseline creatinine) occurred in two T&E patients (9.1%), with none requiring permanent hemodialysis; no significant difference was noted between the two groups (P = .14). One-year mortality and freedom from reintervention in the T&E patients were 81% and 91%, respectively.ConclusionsAcceptable short-term morbidity and mortality can be achieved with T&E compared with TA, despite longer operative times, greater blood loss, and higher contrast exposure. There was a trend toward higher rates of renal and spinal cord injury, so implementation of strategies to reduce the potential of these complications or consideration of staged repair is recommended. Short-term reintervention rates are low, but longer follow-up and greater patient numbers are needed to determine procedural durability and applicability.

Dataset Information

Analysis of Spinal Cord Infarction Associated with Aortic Stent Graft Placement Using Nationwide Inpatient Sample (2002-2011).

Publications

Analysis of Spinal Cord Infarction Associated with Aortic Stent Graft Placement Using Nationwide Inpatient Sample (2002-2011).

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