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Incidence, predictors, and outcomes of spinal cord ischemia in elective complex endovascular aortic repair: An analysis of health insurance claims.

Authors
  • Heidemann, Franziska1
  • Kölbel, Tilo1
  • Kuchenbecker, Jenny1
  • Kreutzburg, Thea1
  • Debus, E Sebastian1
  • Larena-Avellaneda, Axel1
  • Dankhoff, Mark2
  • Behrendt, Christian-Alexander3
  • 1 Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, German Aortic Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , (Germany)
  • 2 DAK-Gesundheit, Hamburg, Germany. , (Germany)
  • 3 Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, German Aortic Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: [email protected] , (Germany)
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Sep 01, 2020
Volume
72
Issue
3
Pages
837–848
Identifiers
DOI: 10.1016/j.jvs.2019.10.095
PMID: 32005486
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study aimed to determine predictors and outcomes associated with spinal cord ischemia (SCI) after elective fenestrated or branched endovascular aneurysm repair (F/BEVAR) of thoracoabdominal aortic aneurysm (TAAA), abdominal aortic aneurysm (AAA), or aortic dissection. Health insurance claims data of Germany's third largest insurance provider, DAK-Gesundheit, were used to investigate SCI in elective F/BEVAR performed between 2008 and 2017. The International Classification of Diseases and German Operation and Procedure Classification System were used. We stratified the results into F/BEVAR with one or two (AAA) vs three or more (TAAA) fenestrations or branches. A total of 877 patients (18.9% female; 5.8% with SCI) matching the inclusion criteria were identified during the study period. SCI occurred more often after F/BEVAR of TAAA vs AAA (10.7% vs 3.0%; P < .001). SCI was associated with female sex in the AAA group (odds ratio, 3.87; 95% confidence interval [CI], 1.25-11.15; P = .014) and with cardiac arrhythmias in the TAAA group (odds ratio, 2.98; 95% CI, 1.24-7.06; P = .013). Compared with patients without SCI, SCI patients were more likely to suffer from drug use disorders (eg, opioids, cannabinoids, sedatives) in the TAAA group (17.6% vs 2.1%; P < .05). After F/BEVAR of TAAA, the occurrence of SCI was associated with higher 90-day mortality (14.7% vs 1.1%; P < .05), longer postoperative hospital stay (22 vs 9 days; P < .05), and severe adverse events, such as acute respiratory insufficiency (44.1% vs 12.7%), acute renal failure (35.3% vs 11.3%), and pneumonia (29.4% vs 4.9%; all P < .05). In adjusted analyses, SCI was associated with worse long-term survival after F/BEVAR for TAAA (hazard ratio, 2.54; 95% CI, 1.37-4.73; P < .003). Female AAA patients and TAAA patients with cardiac arrhythmias are at highest risk for development of SCI after F/BEVAR. The occurrence of this event was strongly associated with higher major complication rates and worse short-term and long-term survival. This emphasizes a need to further illuminate the value of spinal cord protection protocols in F/BEVAR. Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

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