Low Preoperative Prealbumin Levels Are a Strong Independent Predictor of Postoperative Cerebrospinal Fluid Leak following Endoscopic Endonasal Skull Base Surgery

Objective: Pre-albumin levels strongly correlate with a patient's overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative pre-albumin levels independently predict a higher risk for post-operative cerebrospinal fluid (CSF) leak and infection after endoscopic endonasal skull base surgery (EESBS).

Methods: Between October 2019 and January 2020, ninety-eight consecutive patients with confirmed intraoperative CSF leaks, and available preoperative prealbumin levels within 30 days of surgery, were prospectively identified. The incidence of CSF leaks and infections in patients with low-prealbumin levels (≤20 mg/dL) was compared to those with normal prealbumin levels (>20 mg/dL). Numerous factors previously shown to influence CSF leak rates were assessed. Both univariate and multivariate analyses were performed to identify independently predictive factors of postoperative CSF leak.

Results: In this cohort of high-risk patients, with >95% representing expanded EESBS, 14 of 98 patients (14.3%) experienced a postoperative CSF leak. Factors that were approaching significance in our univariate model (p < 0.2), were used in a multivariate model. Low prealbumin levels (≤20 mg/dL) proved to be a strong independent predictive factor associated with a five-fold increased risk for post-operative CSF leak (OR: 5.3, p < 0.01), as well as a higher risk for postoperative infection (OR: 1.5, p = 0.036). This association remained after controlling for multiple other factors including: body mass index, location and pathology of the lesion, high vs low flow CSF leaks, and prior surgery or radiation among others.

Conclusions: Preoperative prealbumin levels are an independent predictor of post-operative CSF leak in patients undergoing EESBS. This is the first objective lab measure shown to predict postoperative EESBS complications. Future studies are warranted to investigate utility of screening and correcting prealbumin levels to limit post-operative complications following EESBS.

Publication History

Article published online:
12 February 2021