Systematic review of motor evoked potentials monitoring during thoracic and thoracoabdominal aortic aneurysm open repair surgery: a diagnostic meta-analysis.
Motor evoked potential (MEP) monitoring has been used to prevent neurological complications such as paraplegia in patients who underwent thoracic or thoracoabdominal aortic aneurysm (TAA/TAAA) surgery. The object of this study was making a systematic review to survey the performance of MEP monitoring during TAA/TAAA open repair surgery. We searched electronic databases for relevant studies. We summarized the diagnostic data with summary sensitivity, summary specificity and forest plots of pooled sensitivity, and conducted sub-group analysis. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We also surveyed the reporting rate of clinical key factors such as methods of anesthesia, surgery, and success rate of MEP. Nineteen studies met our criteria. The results of meta-analysis showed 89.1 % summary sensitivity (95 % confidence interval 47.9-98.6 %) and 99.3 % summary specificity (95 % confidence interval 96.1-99.9 %). Sub-group analysis of pooled sensitivity and specificity by all-or-none cut-off point were better than other cut-off points. The results of the QUADAS-2 were not good. The performance of MEP monitoring was good for detecting postoperative paraplegia in TAA/TAAA open repair surgery. The cut-off point of all-or-none may be the best, according to our review.
Department of Anesthesiology, Nara Medical University, 840 shijo-cho, Kashihara, Nara, 634-8522, Japan. tanakayuu717@gmail.com.
Yuu
0000-0003-3060-2144
Y
Tanaka
Department of Anesthesiology, Nara Medical University, Kashihara, Japan.
Masahiko
M
Kawaguchi
Division of General Internal Medicine, Daini Red Cross Hospital, Nagoya, Japan.
Yoshinori
Y
Noguchi
Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Kenji
K
Yoshitani
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan.
Mikito
M
Kawamata
Department of Anesthesiology, National Defense Medical College, Saitama, Japan.
Kenichi
K
Masui
Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.
Takeo
T
Nakayama
Department of Anesthesiology, The University of Tokyo, Bunkyo, Tokyo, Japan.
Yoshitugu
Y
Yamada
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D012680:Sensitivity and Specificity; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods
Diagnostic meta-analysis; Motor evoked potential (MEP) monitoring; Systematic review; TAAA open repair