Introduction: Spontaneous and iatrogenic skull base cerebrospinal fluid (CSF) leakage are highly morbid conditions requiring neurosurgical intervention for repair. Current literature has not investigated the rate of postoperative complications following craniotomy and secondary repair for CSF leakage. Our objective was to utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to characterize 30-day postoperative complications following CSF leak repair.
Methods: Patients who underwent craniotomy (CPT code: 62100) or secondary repair for CSF leakage (CPT codes: 61618, 61619) were retrospectively reviewed from the 2005-2015 ACS-NSQIP. The prevalence of 30-day postoperative complications was estimated. Multivariable logistic regression modeling was used to identify demographic, comorbid, and perioperative characteristics associated with any morbidity, severe (Clavien IV) complications, and mortality.
Results: Within 634 cases, the prevalence of any morbidity, severe complications, and mortality was 28.08%, 10.73%, and 4.10%, respectively. The three most common complications were: transfusion within 72 hours (11.51%), reoperation (8.99%), and prolonged ventilation >24 hours (8.20%). In multivariable logistic regression analysis, there were three predictors that were significant for each of the outcomes of interest: 1) dependent functional status; 2) American Society of Anesthesiologists (ASA) class III-V; and 3) emergent surgery. Other predictors included age, disseminated cancer, preoperative sepsis, and duration of surgery. The area under the curve (AUC) from multivariable models for any morbidity, severe complications, and mortality were 0.75, 0.82, and 0.91, respectively.
Conclusions: Surgery for skull base CSF leak repair is high risk, with at least one non-fatal complication occurring in over 1 in 4 patients and mortality occurring in 1 in 25 patients. The authors found that increasing age, dependent functional status, disseminated cancer, preoperative sepsis, higher ASA classification, emergent surgery, and duration of surgery were associated with increased risk for postoperative complications following skull base CSF leak repair.
Patient Care: This study provides estimates for the prevalence of postoperative complications following skull base CSF leak repair. When applied to clinical practice, this research will help guide decisions on how to optimize outcomes of patients requiring repair of CSF leakage.
Learning Objectives: At the conclusion of this session, participants should be able to: 1) estimate the prevalence of any morbidity, severe (Clavien IV) complications, and mortality following CSF leak repair; and 2) identify risk factors for postoperative complications following CSF leak repair.