title: Outcomes of outpatient endoscopic repair of cerebrospinal fluid rhinorrhea.
abstract: Endoscopic repair of anterior skull-base defects has become the gold standard for management of cerebrospinal fluid (CSF) rhinorrhea. Both improved techniques and adjuvant therapies have led to accepted success rates of greater than 90%. As management has evolved, shorter hospitalizations have been required and the goal of this study is to analyze the outcomes of patients repaired on an outpatient basis vs those managed as inpatients postoperatively.
  
  
  
  Patients undergoing endoscopic repair of CSF rhinorrhea between 2004 and 2014 were identified by review of medical records. Demographic and clinical data were collected and compared between patients having surgery with and without postoperative admission. Patients managed with lumbar drains were not included. Statistical analyses were preformed to determine if any differences in patient demographics and outcomes existed.
  
  
  
  A total of 86 patients were identified; 39 of 86 patients (45.3%) underwent outpatient surgery; 47 patients were admitted postoperatively with a mean hospital stay of 1.66 days with a median and mode of 1 day. No statistically significant differences were found between leak location, etiology, rates of recurrence, or complications. The outpatient group was found to have a greater proportion of small defects <1 cm2(p = 0.003). Repair technique was also significantly different between groups (p = 0.001).
  
  
  
  Endoscopic management of CSF rhinorrhea is a safe method of treatment with reliable success rates. Our retrospective analysis revealed comparable outcomes in patients treated with and without postoperative hospital admission, and supports the idea that outpatient management may be reasonable in certain patients, especially those with defects <1 cm2.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Austin S
authors.initials: AS
authors.lastname: Adams
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN. paul.t.russell@vanderbilt.edu.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Russell
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D019291:Skull Base / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome
keywords: ambulatory surgery; anterior skull base; cerebrospinal fluid leak; cerebrospinal fluid rhinorrhea; endoscopic; outpatient; skull-base defect; spontaneous CSF leak