[Complications of cerebrospinal fluid drainage after thoracoabdominal aortic surgery (systematic review and meta-analysis)].

Abstract

Relevance: Currently, only one method of spinal cord protection-cerebrospinal fluid (CSF) drainage - has been rated as level 1 evidence in international guidelines for thoracoabdominal aortic aneurysm surgery. However, in recent years, there has been increased attention to complications of CSF drainage, such as intracranial hemorrhage. The aim determination of the frequency and risk factors of complications of CSF drainage during operations for thoracoabdominal aortic aneurysms.

Material and methods: A search of publications in the PubMed (Medline), Google Scholar, and Russian Science Citation Index (eLibrary) databases was conducted according to the PRISMA criteria. The ROBINS1 and ROBINS2 scales were used to assess the methodological quality of the studies. The pooled complication rate was calculated using a random-effects model (DerSimonian-Laird). Univariate (subgroup analysis) and meta-regression analyses were performed to assess the influence of the following parameters on the complication rate of CSF drainage: study type, article publication date, surgical approach, target CSF threshold pressure, CSF drainage rate, and CSF drainage method.

Results: The final analysis included 71 articles (10.798 patients) published from 1991 to 2024. In general, the methodological quality of the studies was acceptable, the risk of systematic error remained moderate. According to the meta-analysis, the incidence of all complications of CSF drainage was 11.9% (95% CI 9.7-14.1), the incidence of severe complications was 1.7% (95% CI 1.3-2.0), intracranial symptomatic hemorrhage was 1.3% (95% CI 1.0-1.7), and associated mortality was 1.1% (95% CI 0.1-3.1). High heterogeneity of studies and the absence of significant publication bias were noted. A significant increase in the incidence of complications was revealed in later publications. No differences were found in the incidence of CSF drainage complications depending on the type of publication, type of procedure, CSF pressure threshold used, drainage rate, and drainage technique.

Conclusion: Due to the high complication rate, a careful assessment of the benefits and risks of CSF drainage is necessary. This study highlights the limitations of the available data, the high prevalence of complications associated with CSF drainage, and the need for further research to determine the true complication rate and evaluate various CSF drainage protocols.