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• W2003045983 abstract "I enjoyed the article by Matsuda and colleagues [1Matsuda H. Ogino H. Fukuda T. et al.Multidisciplinary approach to prevent spinal cord ischemia after thoracic endovascular aneurysm repair for distal descending aorta.Ann Thorac Surg. 2010; 90: 561-565Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar] on spinal cord ischemia (SCI) prevention techniques for thoracic endovascular aneurysm repair (TEVAR). However, there are several concerns related to the statistical methodology, and consequently to the conclusions of the article.Spinal cord ischemia occurred in 4 of 60 patients who underwent TEVAR. However, the analysis of SCI risk factors is difficult to interpret. First, using three different statistical software programs, we replicated few p values that were presented and re-analysis is warranted (eg, we confirmed operation time > 240 minutes at p = 0.03 with uncorrected χ2 vs p = 0.64, as presented in the article). Second, with a sample size of 60 patients and an expected SCI incidence near 4%, given the reference to Baril and colleagues [2Baril D.T. Carroccio A. Ellozy S.H. et al.Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair: is the increased risk of spinal cord ischemia real?.Ann Vasc Surg. 2006; 20: 188-194Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar], Yate's corrected χ2 or Fisher's exact test is the appropriate statistical test given approximately 2 to 3 SCI cases (4% of 60) in this study. Although the choice of a statistical test may seem trivial, the conclusions that are drawn with different tests may vary. For example, of the 18 independent variables that were assessed with an uncorrected χ2 as potential predictors of SCI, 7 variables were statistically significant, including blood transfusion, artificial graft at proximal landing zone, number of covered zones ≥ 8, aortic coverage (≥ 250 and ≥ 300 mm), distal uncovered aorta ≤ 60 mm, and re-exploration for bleeding. However, when these data were subjected to Fisher's exact test, the number of covered zones ≥ 8 and distal uncovered aorta ≤ 60 mm were excluded as risk factors. Third, the small number of SCI cases precludes the use of multivariable modeling, and the issue therefore of multiplicity must be considered given the presentation of 18 p values. Finally, the potential for selective reporting must be considered. All outcomes related to extent of aortic stent-graft coverage were continuous variables that were dichotomized with arbitrary cut points, which raises the question of how, when, and why these thresholds were selected. These methodological details should have been added to the article to remove perception of bias, especially given the retrospective nature of this study.The authors should be congratulated for presenting an excellent report, although the reporting of SCI risk factors with TEVAR must be interpreted with caution. I enjoyed the article by Matsuda and colleagues [1Matsuda H. Ogino H. Fukuda T. et al.Multidisciplinary approach to prevent spinal cord ischemia after thoracic endovascular aneurysm repair for distal descending aorta.Ann Thorac Surg. 2010; 90: 561-565Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar] on spinal cord ischemia (SCI) prevention techniques for thoracic endovascular aneurysm repair (TEVAR). However, there are several concerns related to the statistical methodology, and consequently to the conclusions of the article. Spinal cord ischemia occurred in 4 of 60 patients who underwent TEVAR. However, the analysis of SCI risk factors is difficult to interpret. First, using three different statistical software programs, we replicated few p values that were presented and re-analysis is warranted (eg, we confirmed operation time > 240 minutes at p = 0.03 with uncorrected χ2 vs p = 0.64, as presented in the article). Second, with a sample size of 60 patients and an expected SCI incidence near 4%, given the reference to Baril and colleagues [2Baril D.T. Carroccio A. Ellozy S.H. et al.Endovascular thoracic aortic repair and previous or concomitant abdominal aortic repair: is the increased risk of spinal cord ischemia real?.Ann Vasc Surg. 2006; 20: 188-194Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar], Yate's corrected χ2 or Fisher's exact test is the appropriate statistical test given approximately 2 to 3 SCI cases (4% of 60) in this study. Although the choice of a statistical test may seem trivial, the conclusions that are drawn with different tests may vary. For example, of the 18 independent variables that were assessed with an uncorrected χ2 as potential predictors of SCI, 7 variables were statistically significant, including blood transfusion, artificial graft at proximal landing zone, number of covered zones ≥ 8, aortic coverage (≥ 250 and ≥ 300 mm), distal uncovered aorta ≤ 60 mm, and re-exploration for bleeding. However, when these data were subjected to Fisher's exact test, the number of covered zones ≥ 8 and distal uncovered aorta ≤ 60 mm were excluded as risk factors. Third, the small number of SCI cases precludes the use of multivariable modeling, and the issue therefore of multiplicity must be considered given the presentation of 18 p values. Finally, the potential for selective reporting must be considered. All outcomes related to extent of aortic stent-graft coverage were continuous variables that were dichotomized with arbitrary cut points, which raises the question of how, when, and why these thresholds were selected. These methodological details should have been added to the article to remove perception of bias, especially given the retrospective nature of this study. The authors should be congratulated for presenting an excellent report, although the reporting of SCI risk factors with TEVAR must be interpreted with caution." @default.
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• W2003045983 date "2011-05-01" @default.
• W2003045983 modified "2023-09-26" @default.
• W2003045983 title "Spinal Cord Ischemia Risk Factors With Thoracic Endovascular Aneurysm Repair" @default.
• W2003045983 cites W2080800307 @default.
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• W2003045983 doi "https://doi.org/10.1016/j.athoracsur.2010.11.045" @default.
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