Study Design: 

Retrospective cohort study.

Objective: 

We aimed to characterize the treatment patterns and the associated costs in patients with cerebrospinal fluid (CSF) leak after spine procedures in the United States.

Background: 

CSF leak is a common complication after spinal procedures. However, there is a little data regarding the national patterns of treatment choice and the associated health care resource utilization.

Methods: 

We utilized the IBM MarketScan Research databases to retrospectively analyze adult US patients diagnosed with CSF leak within 30 days of spine procedures between 2001 and 2018. Treatment prevalence, treatment failure, and health care resource utilization data within 30 days of the CSF leak were collected. A subanalysis was performed on patients who received epidural blood patches (EBP) to better understand health care utilization attributable to this treatment modality.

Results: 

Twenty one thousand four hundred fourteen patients were identified. The most common causes of CSF leak were diagnostic spinal tap (59.2%) and laminectomy/discectomy (18.7%). With regard to treatment prevalence, 40.4% of the patients (n=8651) had conservative medical management, 46.6% (n=9987) received epidural blood patch repair, 9.6% required surgical repair (n=2066), and 3.3% (n=710) had lumbar drain/puncture. Nine hundred sixty-seven (9.7%), 150 (21.1%), and 280 (13.5%) patients failed initial EBP, lumbar drain, and surgery, respectively, and the overall failure rate was 10.9% (n=1397). The median 30-day total cost across all groups was $5,101. Patients who received lumbar drain ($22,341) and surgical repair ($30,199) had higher 30-day median total costs than EBP ($8,140) or conservative management ($17,012). The median 30-day total cost for patients whose EBP failed ($8,179) was substantially greater than those with a successful EBP repair ($3,439).

Conclusions: 

National treatment patterns and costs for CSF leaks were described. When used in the correct patient cohort, EBP has the lower failure rates and costs than comparable alternatives. EBP may be considered more often in situations where conservative management or lumbar drains are currently being used.

中文翻译：

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美国医源性脊髓脑脊液漏的治疗模式和医疗资源利用

学习规划： 

回顾性队列研究。

客观的： 

我们的目的是了解美国脊柱手术后发生脑脊液 (CSF) 漏的患者的治疗模式和相关费用。

背景： 

脑脊液漏是脊柱手术后常见的并发症。然而，关于国家治疗选择模式和相关医疗保健资源利用的数据很少。

方法： 

我们利用 IBM MarketScan Research 数据库对 2001 年至 2018 年间脊柱手术后 30 天内诊断为脑脊液漏的美国成年患者进行了回顾性分析。收集了脑脊液漏 30 天内的治疗流行率、治疗失败和医疗保健资源利用数据。对接受硬膜外血贴 (EBP) 的患者进行了亚分析，以更好地了解这种治疗方式的医疗保健利用率。

结果： 

已确定 21414 名患者。脑脊液漏最常见的原因是诊断性脊椎穿刺（59.2%）和椎板切除术/椎间盘切除术（18.7%）。就治疗率而言，40.4%的患者（n=8651）接受保守治疗，46.6%（n=9987）接受硬膜外血补片修复术，9.6%需要手术修复（n=2066），3.3%（n=9987）需要手术修复。 =710) 进行了腰椎引流/穿刺。初始 EBP、腰椎引流和手术分别有 967 例 (9.7%)、150 例 (21.1%) 和 280 例 (13.5%) 患者失败，总体失败率为 10.9% (n=1397)。所有组的 30 天总成本中位数为 5,101 美元。接受腰椎引流（22,341 美元）和手术修复（30,199 美元）的患者的 30 天中位总费用高于 EBP（8,140 美元）或保守治疗（17,012 美元）。EBP 失败的患者的 30 天总费用中位数（8,179 美元）远高于 EBP 修复成功的患者（3,439 美元）。

结论： 

描述了脑脊液泄漏的国家治疗模式和费用。当在正确的患者群体中使用时，EBP 的失败率和成本比同类替代方案更低。在目前使用保守治疗或腰椎引流的情况下，可能会更频繁地考虑 EBP。