The Role of Fluoroscopic Guidance in Spinal Drain Placement for Thoracoabdominal Aneurysm Repair Patients: A Retrospective Study.

Objectives: To evaluate outcomes after implementation of a preoperative protocol requiring fluoroscopic guidance in patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair identified as being at risk for spinal drain placement complications.

Design: This retrospective analysis included patients who underwent spinal drain placement for TAAA repair between November 2013 and November 2018. Patient outcomes were assessed before (control) and after (study) protocol implementation.

Setting: Single tertiary care hospital.

Participants: A total of 58 patient records were analyzed.

Intervention: The protocol was implemented in November 2015 to identify at-risk patients for difficult spinal drain placement undergoing TAAA repair who would benefit from placement under fluoroscopic guidance.

Measurement and main results: The mean operating room arrival time to drain placement was lower in the study group than in the control group (44.9 ± 12.7 minutes v 80.5 ± 55.8 minutes; p = 0.03). The mean time to incision was lower in the study group than in the control group (114.9 ± 38.1 minutes v 172.4 ± 32.0 minutes; p < 0.001), and fewer drain placement attempts were done in the study group than in the control group (mean, 1.3 ± 0.7 attempts v 2.7 ± 2.5 attempts; p = 0.006). The mean length of stay was lower in the study group (9.5 ± 6.7 days v 18.7 ± 22.7 days; p = 0.04).

Conclusions: Preoperative identification of at-risk patients before TAAA repair may reduce operating room arrival to the incision time, operating room to spinal drain placement time, number of spinal drain placement attempts, length of hospital stay, and complications associated with spinal drain placement.