No Association Found Between Frailty and Outcome or Complications in Patients Receiving Endoscopic Cerebrospinal Fluid Leak Repair

by Linda Kossoff •

CLINICAL QUESTION

What is the physiological stress impact of surgical frailty in a patient receiving endoscopic cerebrospinal fluid (CSF) leak repair?

BOTTOM LINE

This study suggests that the endoscopic approach to CSF leak repair is well tolerated in the frail population.

BACKGROUND:  Surgical repair is the treatment mainstay for CSF leaks of the anterior cranial base. There has been increased focus on improving outcomes while optimizing patient safety for this procedure. One important metric is preoperative frailty, defined as reduced physiological functioning that results in a higher risk of mortality or dependency. 

STUDY DESIGN:  Retrospective study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health, Detroit, Mich.

SYNOPSIS: Researchers reviewed cases of patients with CSF rhinorrhea undergoing endoscopic repair at two institutions from January 2010–2021. Only traumatic, iatrogenic, and spontaneous CSF leak cases were included. Frailty was calculated using several validated indices, including the American Society of Anesthesiologists (ASA) classification. Primary outcomes were medical and surgical complications and 30-day readmission. The secondary outcome was the success of CSF leak repair. A total of 185 patients (69.2% female, average age 54.2 years, average body mass index 34.6) were included in the analysis. Most patients were ASA class 3 (48.6%). The most common etiology was idiopathic intracranial hypertension (34.6%). A total of 125 patients underwent perioperative lumbar drain placement. Most of the leaks were spontaneous (n = 140), followed by iatrogenic (n = 32) and traumatic (n = 13). All were repaired with an endoscopic-only approach. The overall primary repair success rate was 98.4%. There was no association between frailty and 30-day medical outcomes, surgical outcomes, or readmission. Authors say findings corroborate previous work demonstrating that endoscopic approaches for sinonasal malignancy and suprasellar pathology do not have higher rates of complications in the frail population. Study limitations included its retrospective nature.

CITATION: Eide JG, Kshirsagar RS, Wen C, et al. Endoscopic repair of anterior skull base cerebrospinal fluid leaks is successful in frail patients. Laryngoscope. 2024;134:2713–2717.