Intraoperative Cerebrospinal Fluid Leaks During Endoscopic Endonasal Tumor Resection are Associated With Higher Emesis Rates and Greater Opioid Use in the Acute Postoperative Period.

BACKGROUND AND OBJECTIVES

Cerebrospinal fluid (CSF) leaks are common after endoscopic endonasal approach (EEA). Opioid-induced emesis in the acute postoperative period may play a role in causing these leaks. The purpose of this study was to understand the associations between opioid use, postoperative emesis, and CSF leak occurrence after EEA.

METHODS

A retrospective review of relevant clinical variables among patients who underwent EEA for tumor resection.

RESULTS

In total, 285 patients underwent EEA for tumor resection. Intraoperative CSF leak was significantly associated with a higher incidence of postoperative emesis (51.5% vs 30.6%, P = .002). Sixteen patients (5.6%) developed postoperative CSF leaks (9 in extended EEA cases and 7 in direct EEA cases), which was associated with significantly greater incidence of postoperative emesis (56.3% vs 21.1%, P = .003), greater opioid use per day (24.3 mg vs 15.1 mg, P = .022), and longer mean hospital stay (7.4 days vs 3.2 days, P < .001). Opioid consumption and length of stay were also significantly higher in patients who experienced an intraoperative CSF leak (P = .020) and postoperative emesis (P < .001). In patients with an intraoperative CSF leak, postoperative emesis was associated with a higher postoperative CSF leak rate, but this did not reach statistical significance (20.6% vs 10.4%, P = .139). After initiating an opioid-sparing analgesia protocol (P < .001), incidence of emesis was significantly lower; however, this did not translate to reduced postoperative CSF leak rates (P = .92).

CONCLUSION

Intraoperative CSF leaks serve as an exacerbating factor for postoperative emesis, both of which are associated with increased opioid use and patient length of stay. After implementing an opioid-sparing protocol, emesis rates were lower; however, this did not translate to reduced postoperative CSF rhinorrhea. Future research is necessary to better characterize the causal relationship between these perioperative complications, including the role of opioid minimization to prevent postoperative CSF leaks.