Risk Factors and Interventions for Managing CSF Leaks After Lumbar Fusion Surgery: A Nationwide Study (2016–2021)

Introduction: Cerebrospinal fluid (CSF) leaks are a known complication following lumbar fusion surgery. Despite advancements in surgical techniques, the management of these leaks remains challenging, with varying outcomes based on patient characteristics and surgical approaches. This study aims to identify factors that increase the likelihood of requiring additional interventions for managing CSF leaks after lumbar fusion surgery.

Methods: We used the Nationwide Inpatient Sample (NIS) database from 2016 to 2021 to identify patients who underwent lumbar fusion surgery and experienced postoperative CSF leaks. Patient demographics, surgical approaches, and risk factors were analyzed using multivariate logistic regression models. Secondary outcomes included length of hospital stay (LOS), total hospitalization costs, and in-hospital mortality rates. All statistical analyses were conducted using SPSS.

Results: A total of 13,500 patients with postoperative CSF leaks were identified. Of these, 81.3% (10,972) required further interventions such as epidural blood patches, simple repairs, or surgical management. Over the study period, the rate of interventions increased by 10% annually. Key independent risk factors for requiring interventions included older age (OR: 1.02, 95% CI: 1.01–1.04, p< 0.001), posterior surgical approaches (OR: 1.55, 95% CI: 1.29–1.89, p< 0.001), and obesity (OR: 1.45, 95% CI: 1.18–1.78, p< 0.001). Non-surgical management was associated with significantly longer hospital stays (6.1±4.7 days vs. 5.2±3.8 days; p< 0.001) but similar hospitalization costs and mortality rates between groups.

Conclusion : The findings suggest that certain factors, such as advanced age, posterior approaches, and obesity, significantly increase the likelihood of requiring an intervention for CSF leak management following lumbar fusion surgery. Awareness of these risk factors can guide preoperative planning and improve patient outcomes.