Perspective:

Aortic aneurysm and dissection are not mutually exclusive, and these diagnoses often coexist in the same patient, but may or may not be coded as such. The approach used in this retrospective administrative data analysis therefore may have been limited by misclassification. Lack of anatomic data (including aneurysm diameter, branch patency, and extent of aortic replacement or coverage) are other factors that limit conclusions that can be drawn from this analysis.

These limitations aside, administrative data can often be a valuable source of evidence related to adverse perioperative events, providing evidence from a spectrum of low-, medium-, and high-volume centers while avoiding negative publication bias. This study provides useful information related to rates and risk factors for SCI, a rare but potentially devastating complication for patients undergoing aortic procedures. The results support previously published findings suggesting increased risk of SCI associated with procedures performed as emergencies or dissection as the primary diagnosis. The higher SCI rate observed after surgical repair of intact aneurysms warrants consideration during treatment selection, although the absolute risk reduction associated with endovascular repair was small in magnitude and therefore might not always justify tradeoffs with long-term, aneurysm-specific outcomes.