Cerebrospinal-fluid drain-related complications in patients undergoing open and endovascular repairs of thoracic and thoraco-abdominal aortic pathologies: a systematic review and meta-analysis

Abstract Background Cerebrospinal-fluid (CSF) drainage is recommended by current guidelines for spinal protection during open and endovascular repairs of thoracic and thoraco-abdominal aortic aneurysms. In the published literature, great variability exists in the rate of CSF-related complications and morbidity. Herein, we perform a systematic review and meta-analysis on the incidence of CSF drainage-related complications, and compare the complication rates between open and endovascular repairs. Methods The systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. Thirty-four studies (4714 patients) were included in the quantitative analysis. The CSF drainage-related complications were categorised as mild, moderate, and severe. Pooled event rates for each complication category were estimated using a random-effect model. Random-effect uni- and multivariable meta-regression analyses were used to assess the effect of aortic-repair approach (open vs endovascular) and the CSF drainage criteria on CSF drainage-related complications. Results The pooled event rates were 6.5% [95% confidence interval (CI): 4.3–9.8%] for overall complications, 2% (95% CI: 1.1–3.4%) for minor complications, 3.7% (95% CI: 2.5–5.6%) for moderate complications, and 2.5% (95% CI: 1.6–3.8%) for severe complications. The drainage-related-mortality pooled event rate was 0.9% (95% CI: 0.6–1.4%). The uni- and multivariable meta-regression analyses showed no difference in complication rates between the open and endovascular approaches, or between the different CSF drainage protocols. Conclusion The complication rate for CSF drainage is not negligible. Our results help define a more accurate risk–benefit ratio for CSF drain placement at the time of repair of thoracic and thoraco-abdominal aneurysms.