School of Medicine, University of California San Diego, La Jolla, California.
Division of Neurological Surgery, University of California San Diego, San Diego, California.
Neurosurgery. 2018 May 1;82(5):630-637. doi: 10.1093/neuros/nyx197.
Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis.
To identify risk factors for and timing of 30-d readmission with CSF leak.
Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression.
A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge.
This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.
脑脊液（CSF）漏是桥小脑角肿瘤切除术后一种公认的并发症，与许多继发性并发症有关，包括再次入院和脑膜炎。
确定 CSF 漏的 30 天再入院的危险因素和时间。
在加利福尼亚州全州卫生规划和发展数据库中确定了 1995 年至 2010 年接受前庭神经鞘瘤切除术的患者。通过国际疾病分类，第九修订版诊断代码确定最常见的入院诊断，并使用逻辑回归确定 CSF 漏再入院的预测因素。
共确定了 6820 名患者。CSF 漏虽然是出院后入院的相对少见原因（所有患者的 3.52%），但在 490 次再入院中有近一半（48.98%）与 CSF 漏有关。CSF 漏再入院的显著独立预测因素为男性（比值比 [OR] 1.72，95%置信区间 [CI] 1.32-2.25）、首次入院在教学医院（OR 3.32，95%CI 1.06-10.39）、首次入院时 CSF 漏（OR 1.84，95%CI 1.33-2.55）、首次入院时肥胖（OR 2.10，95%CI 1.20-3.66）和首次入院医院的病例量（首次入院医院病例量的对数 OR 0.82，95%CI 0.70-0.95）。从出院到再入院的中位时间为 6 天。
本研究量化了 CSF 漏是前庭神经鞘瘤手术后近一半再入院的重要原因。我们建议外科医生应关注可能减少 CSF 漏的技术因素，并利用潜在的 CSF 漏检测筛查策略，在首次入院出院前进行检测。
