Predictors of length of postoperative stay following endoscopic skull base surgery with intraoperative CSF leak

OBJECTIVE Establishing benchmarks for length of stay (LOS) may inform strategies to improve resource efficiency, decrease costs, and advance care quality. In this study, the authors characterize postoperative LOS in endoscopic skull base surgery (ESBS) and elucidate prolonging factors. METHODS A retrospective chart review was conducted at a tertiary academic center including consecutive adult patients who underwent intradural ESBS with intraoperative CSF leak during primary repair between July 2018 and March 2024. LOS, calculated as the time between the end of anesthesia until discharge from the hospital, comprised the primary outcome. Categorical and continuous independent study variables were assessed for univariate LOS association via the Mann-Whitney U-test and Kendall’s tau-b correlation, respectively, and those with significant associations were included as multiple linear regression inputs. RESULTS One hundred sixty-three patients were included, with a median LOS of 4.0 (interquartile range [IQR] 2.8–5.8) days. LOS was significantly prolonged in high-flow (n = 82) compared with low-flow (n = 81) CSF leak cohorts (median 4.5 [IQR 3.9–6.5] vs 2.9 [IQR 2.1–4.7] days, p = 0.002). Defects involving the anterior cranial fossa (n = 16, median 4.6 [IQR 3.3–7.5)] days), suprasellar region (n = 94, median 4.4 [IQR 3.2–6.4] days), sella (n = 138, median 3.9 [IQR 2.8–5.8] days), or posterior cranial fossa (n = 17, median 4.5 [IQR 3.9–6.5] days) had variable LOSs. On multiple linear regression, after controlling for numerous patient, surgical, and postoperative factors, lesion diameter (B = 0.16, 95% CI 0.048–0.26), bone defect area (B = 0.008, 95% CI 0.001–0.014), anesthesia time (B = 0.015, 95% CI 0.004–0.026), bed rest length (B = 2.34, 95% CI 1.12–3.56), postoperative CSF leak (B = 11.06, 95% CI 4.11–18.01), postoperative meningitis (B = 11.79, 95% CI 4.83–18.74), postoperative stroke/hemorrhage (B = 25.25, 95% CI 18.43–32.06), and postoperative pneumonia (B = 5.59, 95% CI 0.79–10.38) independently predicted overall prolonged LOS. CONCLUSIONS With healthcare utilization receiving increased attention, mitigating factors that extend LOS are important. Extent of surgery and certain postoperative complications may constitute key factors prolonging LOS following intradural ESBS with intraoperative CSF leak.