title: Assessing risk/benefit of lumbar drain use for endoscopic skull-base surgery.
abstract: BACKGROUND
  Lumbar drains (LD) are frequently employed with the goal of postoperative cerebrospinal fluid (CSF) leak prevention. LD placement is not without risk, however, and complications can significantly increase patient discomfort and resource utilization. The objective of this work was to characterize the risks, benefits, and resource utilization associated with LD use in endoscopic anterior skull-base surgery.
  
  
  METHODS
  A retrospective review of endoscopic anterior skull-base surgeries performed by the senior authors over the past 5 years was done. Cases with prospective LD were selected using anesthesia and billing records. Analysis was done of indications, LD duration, complications, revisions, and additional care required.
  
  
  RESULTS
  A total of 65 patients had LD placed prospectively at the time of surgery. LD were in place for an average of 63 ± 38 hours. Four cases (6.2%) required revision surgery for postoperative CSF leak. Leak rates did not differ between patients with neoplasm (7.7%) and without neoplasm (5.8%; p = 0.80). One readmission was attributable to a recurrent leak. Nine LD complications occurred in 8 patients (12.3%). Overall, 6 blood patches, 3 head computed tomography (CT) scans, 1 open removal of retained catheter fragments, 1 spine CT, and an infectious disease workup were required. Three readmissions and 10 additional hospital days were attributable to LD complications. No relationship was found between patient demographics or comorbidities and LD complications. Regression analysis showed no significant effect of body mass index (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.89-1.14; p = 0.87) or duration of LD (OR, 1.00; 95% CI, 0.98-1.02; p = 0.85) on complication risk. Diagnosis of neoplasm was associated with a significant increase in likelihood of complication (OR, 5.33; 95% CI, 1.11-25.64; p < 0.04).
  
  
  CONCLUSIONS
  Complications of LD may be more frequent than postoperative CSF leaks, adding significantly to health care resource utilization. It is difficult to predict which patients will suffer LD complications. Reduction of prospective LD use may avoid unnecessary morbidity and resource utilization.
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA. evan.ransom@uphs.upenn.edu
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D004322:Drainage / Q000009:adverse effects*; D004677:Encephalocele / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects*; D005626:Frontal Sinus / Q000293:injuries; D006801:Humans; D007902:Length of Stay; D008161:Lumbosacral Region; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012421:Rupture; D019291:Skull Base / Q000601:surgery*