TY - JOUR
T1 - Lumbar Drain for Temporary Cerebrospinal Fluid Diversion
T2 - Factors Related to the Risks of Complications at a University Hospital
AU - Bakhshi, Saqib Kamran
AU - Suhail, Nawal
AU - Mitha, Rida
AU - Moazzam, Mujtaba
AU - Zahid, Nida
AU - Shamim, Muhammad Shahzad
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: Lumbar drains (LDs) are often used for temporary cerebrospinal fluid (CSF) diversion. However, limited data are available on the risk factors associated with complications. We reviewed our institutional LD data to identify the common indications and outcomes, including the risk factors associated with the occurrence of complications. Methods: We performed a retrospective review of the patient medical records. All adult patients, who had an LD placed at our hospital during a 5-year period, were included in the present study. The Fisher Exact test and Mann-Whitney U test were used to compare the categorical data and continuous data, respectively; p ≤ 0.05 was considered to indicate statistical significance. Results: During the study period, 211 patients had an LD placed and were included in the present study, of whom 133 were men (63.0%). The most common reason for LD placement was for an iatrogenic CSF leak and pseudomeningocele in 95 patients (45.0%). The mean duration of an indwelling LD was 3.7 ± 1.9 days. Meningitis was the most common complication after LD insertion, occurring in 12 patients (5.5%), followed by low pressure headaches in 10 patients (4.8%). Escherichia coli and Pseudomonas aeruginosa were the most common organisms on culture. Manipulation of the LD to draw CSF samples for analysis was a significant risk factor for the development of meningitis (p = 0.039). Conclusions: The most common complications in our institution were meningitis and low pressure headaches. Minimizing LD manipulation during CSF sampling could potentially decrease the risk of meningitis. Our protocol of continuing routine prophylactic antibiotics for patients with an indwelling LD might reduce the risk of meningitis; however, the results from a prospective cohort study would provide stronger evidence.
AB - Objective: Lumbar drains (LDs) are often used for temporary cerebrospinal fluid (CSF) diversion. However, limited data are available on the risk factors associated with complications. We reviewed our institutional LD data to identify the common indications and outcomes, including the risk factors associated with the occurrence of complications. Methods: We performed a retrospective review of the patient medical records. All adult patients, who had an LD placed at our hospital during a 5-year period, were included in the present study. The Fisher Exact test and Mann-Whitney U test were used to compare the categorical data and continuous data, respectively; p ≤ 0.05 was considered to indicate statistical significance. Results: During the study period, 211 patients had an LD placed and were included in the present study, of whom 133 were men (63.0%). The most common reason for LD placement was for an iatrogenic CSF leak and pseudomeningocele in 95 patients (45.0%). The mean duration of an indwelling LD was 3.7 ± 1.9 days. Meningitis was the most common complication after LD insertion, occurring in 12 patients (5.5%), followed by low pressure headaches in 10 patients (4.8%). Escherichia coli and Pseudomonas aeruginosa were the most common organisms on culture. Manipulation of the LD to draw CSF samples for analysis was a significant risk factor for the development of meningitis (p = 0.039). Conclusions: The most common complications in our institution were meningitis and low pressure headaches. Minimizing LD manipulation during CSF sampling could potentially decrease the risk of meningitis. Our protocol of continuing routine prophylactic antibiotics for patients with an indwelling LD might reduce the risk of meningitis; however, the results from a prospective cohort study would provide stronger evidence.
KW - CSF diversion
KW - CSF leak
KW - Lumbar drain
KW - Meningitis
UR - http://www.scopus.com/inward/record.url?scp=85089363727&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2020.07.120
DO - 10.1016/j.wneu.2020.07.120
M3 - Article
C2 - 32711138
AN - SCOPUS:85089363727
SN - 1878-8750
VL - 143
SP - e193-e198
JO - World Neurosurgery
JF - World Neurosurgery
ER -