Short Postoperative Length of Stay After Cerebrospinal Fluid Leak Repair

Introduction: This tertiary medical center historically has a short length of stay following CSF leak repair, with few post-operative complications. We aimed to characterize the safety and outcomes after lateral skull base cerebrospinal fluid (CSF) leak repairs followed by a shortened length of stay protocol.

Methods: Retrospective chart review at a tertiary medical center from July 2016 through 2022. 156 adult patients who underwent CSF leak repair via transmastoid (TM), middle cranial fossa (MCF) or combined (TM and MCF) approaches were included. Data collected includes: length of stay (LOS), presentation to the emergency department (ED), need for readmission, major neurologic complications (stroke, seizure, and meningitis), and CSF leak recurrence.

Results: Approaches for CSF leak repair were fairly evenly split between TM approach (49.4%) and combined repair (46.8%) with 3.8% having solely MCF repair. No peri/post-operative lumbar drains were used to facilitate repair and only 2 (1.3%) patients were admitted to the ICU after surgery, though these were precautionary and both patients were released to the floor the next day. The overall average LOS was 1.02 ± 0.73 days and was longer for surgeries that involved MCF (1.25 ± 0.73) compared to TM (0.78 ± 0.66) (p < 0.0001). Patients were discharged same-day or on post-operative day 1 in 72.2% of combined or MCF approaches and 92.2% of TM cases. There were no major neurological complications during inpatient stay or after discharge for any approach. Of the patients studied, 6 (3.8%) presented to an ED for minor complications including 3 (1.9%) for medication intolerance, 1 (0.6%) for incisional infection, 1 (0.6%) for subjective swelling, and 1 (0.6%) for meningitis rule out. None of these patients required admission. Re-operation within 60 days was required in 3 (1.9%) patients.

Conclusions: Our findings suggest that short LOS after surgical repair of lateral skull base defects in the treatment of CSF leak is safe and should be considered in normal practice.