Abstract

Spinal drains (SD) are an important component of spinal cord protection for patients undergoing complex aortic surgery. However, SDs are not benign and can lead to important complications such as intracranial hemorrhage and spinal hematomas. We sought to evaluate the outcomes of SD placement, including drain-related complications and spinal cord ischemia at a university hospital center in Montreal, Canada. Patients who underwent SD placement between 2014 and 2020 were identified using procedure codes. A retrospective chart review was then performed to identify patient demographics, comorbidities, characteristics of the index surgery, postoperative outcomes, and SD-related complications. Seventy-nine patients underwent preoperative SD placement. Sixty-six percent of patients were male and the mean age at the time of procedure was 66 years. Fifty-seven percent of patients presented with isolated thoracic aortic aneurysms and 43% presented with thoracoabdominal aortic aneurysms. Thirty-eight patients (48.1%) underwent advanced endovascular repair. Intraoperative drain placement was obtained with an average of 1.3 attempts, however this increased to 1.8 attempts in patients who experienced SD-related events (P = .032). Multiple attempts at placement was associated with an increase in SD events (P = .004). Ten patients (12.7%) experienced intraoperative SD events, including 6 patients (7.6%) who reported transient paresthesia requiring drain removal and new drain placement, 3 patients (3.8%) who had a bloody spinal tap, causing 1 drain placement to be aborted, and 1 patient who developed a hematoma at the drain insertion site and subsequently had their drain removed. Of the patients who experienced intraoperative SD events, three (3.8%) developed postoperative SD complications in addition to seven patients (8.9%) who developed new drain-related complications. Four patients (5.1%) had bloody drain output, two patients (2.5%) had a cerebrospinal fluid leak, two patients (2.5%) experienced intracerebral hemorrhages without long-term sequelae, one of the placed drains malfunctioned, and one patient had prolonged bleeding around the drain site. Spinal cord ischemia occurred in five patients (6.3%) total, two of whom experienced permanent disability. Of the five cases of SCI, three (3.8%) occurred in patients who had experienced SD complications. Postoperative SD-related complications occurred in 12.7% of patients undergoing aortic surgery, were more likely to occur when multiple attempts at SD placement occurred, and were associated with an increased risk of spinal cord ischemia. Lack of vascular-specialized anesthesiologists, participation of residents in SD placement and difficult patient anatomy may all have contributed to increasing the number of attempts required for SD placement.

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