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.