Preoperative vs. Immediate Postoperative Prophylactic CSF Drainage: Outcomes in PSM-Matched Open Thoracoabdominal Aortic Replacement
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0150
Submission Type:
Abstract Submission
Authors:
Bo Jia (1), Chengnan Li (2), Yipeng Ge (2), Haiou Hu (2), Zhiyu Qiao (2), JUNMING ZHU (3)
Institutions:
(1) Beijing Anzhen Hospital Capital Medical University, Beijing, Beijing, (2) Beijing Anzhen Hospital of Capital Medical University, Beijing, NA, (3) N/A, BEIJING, China
Submitting Author:
Bo Jia
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Beijing Anzhen Hospital Capital Medical University
Beijing Anzhen Hospital Capital Medical University
Co-Author(s):
Chengnan Li
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Beijing Anzhen Hospital of Capital Medical University
Beijing Anzhen Hospital of Capital Medical University
Yipeng Ge
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Beijing Anzhen Hospital of Capital Medical University
Beijing Anzhen Hospital of Capital Medical University
Haiou Hu
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Beijing Anzhen Hospital of Capital Medical University
Beijing Anzhen Hospital of Capital Medical University
Zhiyu Qiao
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Beijing Anzhen Hospital of Capital Medical University
Beijing Anzhen Hospital of Capital Medical University
JUNMING ZHU
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N/A
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Presenting Author:
Bo Jia
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Beijing Anzhen Hospital Capital Medical University
Beijing Anzhen Hospital Capital Medical University
Abstract:
Objective: To evaluate whether immediate postoperative prophylactic cerebrospinal fluid (CSF) drainage outperforms preoperative timing in reducing spinal cord ischemia (SCI) and stroke risk in propensity score-matched (PSM) open thoracoabdominal aortic replacement (OTAAR) patients, addressing the evidence gap in balanced cohorts distinct from salvage strategies.
Methods: This retrospective PSM cohort study evaluated 727 OTAAR patients at a single high-volume center (January 2009–December 2024). Prophylactic CSF drainage groups were stratified as preoperative or immediate postoperative (within 1-hour post-closure), excluding salvage cases, pregnancies, simple thoracic/abdominal aortic replacements, inflammatory, or infectious aneurysms. After exclusions, 647 patients were included (96 no-drainage, 415 preoperative, 136 postoperative). PSM (1:1 nearest-neighbor matching, caliper 0.1) balanced covariates. Multivariable logistic regression assessed SCI predictors, and Cox proportional hazards modeled long-term all-cause mortality. Kaplan-Meier (KM) curves with log-rank tests evaluated survival.
Results: Overall, CSF drainage significantly reduced SCI incidence (no-drainage group: 11.5%, preoperative group: 7.7%, immediate postoperative group: 2.9%, P=0.041). In the drainage cohort, 120 matched pairs (N=240) achieved balanced baseline characteristics. SCI rates trended lower in the immediate postoperative group (3.3% vs 7.5%, P=0.254), with comparable inhospital mortality (5.0% vs 4.2%, P=1.000). Stroke incidence was significantly reduced (0% vs 6.7%, P=0.007). Multivariable logistic regression identified immediate postoperative drainage as an independent SCI protector (OR=0.22, 95% CI 0.07–0.72, P=0.013). Long-term survival showed no group differences (KM log-rank P=0.883), with multivariable Cox revealing advanced age as a mortality risk factor (HR=1.06, 95%CI 1.03-1.08, P<0.001) and hemoglobin as a protector (HR=0.98, 95%CI 0.97-0.99, P<0.001).
Conclusions: Prophylactic CSF drainage mitigates SCI risk in OTAAR. Immediate postoperative placement independently protects against SCI and reduces stroke incidence compared to preoperative timing, without survival differences. These findings support refined prophylactic drainage protocols to optimize neuroprotection in complex aortic surgery.
Methods: This retrospective PSM cohort study evaluated 727 OTAAR patients at a single high-volume center (January 2009–December 2024). Prophylactic CSF drainage groups were stratified as preoperative or immediate postoperative (within 1-hour post-closure), excluding salvage cases, pregnancies, simple thoracic/abdominal aortic replacements, inflammatory, or infectious aneurysms. After exclusions, 647 patients were included (96 no-drainage, 415 preoperative, 136 postoperative). PSM (1:1 nearest-neighbor matching, caliper 0.1) balanced covariates. Multivariable logistic regression assessed SCI predictors, and Cox proportional hazards modeled long-term all-cause mortality. Kaplan-Meier (KM) curves with log-rank tests evaluated survival.
Results: Overall, CSF drainage significantly reduced SCI incidence (no-drainage group: 11.5%, preoperative group: 7.7%, immediate postoperative group: 2.9%, P=0.041). In the drainage cohort, 120 matched pairs (N=240) achieved balanced baseline characteristics. SCI rates trended lower in the immediate postoperative group (3.3% vs 7.5%, P=0.254), with comparable inhospital mortality (5.0% vs 4.2%, P=1.000). Stroke incidence was significantly reduced (0% vs 6.7%, P=0.007). Multivariable logistic regression identified immediate postoperative drainage as an independent SCI protector (OR=0.22, 95% CI 0.07–0.72, P=0.013). Long-term survival showed no group differences (KM log-rank P=0.883), with multivariable Cox revealing advanced age as a mortality risk factor (HR=1.06, 95%CI 1.03-1.08, P<0.001) and hemoglobin as a protector (HR=0.98, 95%CI 0.97-0.99, P<0.001).
Conclusions: Prophylactic CSF drainage mitigates SCI risk in OTAAR. Immediate postoperative placement independently protects against SCI and reduces stroke incidence compared to preoperative timing, without survival differences. These findings support refined prophylactic drainage protocols to optimize neuroprotection in complex aortic surgery.
ADULT CARDIAC:
Aorta and Great Vessels
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