OBJECTIVES: To describe the variation in patient and procedural characteristics by intervention selection for cranial dural tears

METHODS: Retrospective analysis of hospital data from the PINC AI^TM Healthcare Database. Included patients aged ≥18 years and had an inpatient hospital encounter for craniotomy/craniectomy between October 1, 2015 and March 31, 2023 (first=index). Patients were stratified by dural tear repair intervention: primary closure (PC) only, PC plus patch or graft (PC+P/G), PC plus sealant (PC+S), or PC plus patch or graft and sealant (PC+P/G+S). Patient and procedural characteristics (e.g., age, sex, elective v non-elective, surgical approach [burr hole, endoscopic, open]) were measured at index. Operating room (OR) time and 30-day CSF leak rates were characterized descriptively for each intervention.

RESULTS: The study comprised 100,087 patients: 39% (n=39,002) PC only (median age 63; 44.5% female), 38% (n=38,029) PC+P/G (median age 61; 49.2% female), 13.4% (n=13,413) PC+S (median age 56; 55.8% female), 9.6% (n=9,643) PC+P/G+S (median age 58; 55.2% female). There was substantial variation in the proportion of elective admissions (PC only=37.4%, PC+P/G=41.2%, PC+S=70.0%, PC+P/G+S=60.8%). Overall, the majority of procedures used an open approach (PC only=84.7%, PC+P/G=95.3%, PC+S=75.7%, PC+P/G+S=87.9%); however, the proportion of patients with burr hole (PC=7.8%, PC+P/G=1.2%, PC+S=1.5%, PC+P/G+S=1.1%) and endoscopic (PC=7.5%, PC+P/G=3.5%, PC+S=22.8%, PC+P/G+S=11.0%) approaches varied considerably by intervention. Observed median OR time increased across PC only (208.4 minutes), PC+P/G (242.8 minutes), PC+S (282.39 minutes), and PC+P/G+S (296.9 minutes). Incidence proportions of 30-day CSF leak increased similarly across the four intervention groups, PC only=0.69%, PC+P/G=0.99%, PC+S=2.35%, and PC+P/G+S=2.61%.

CONCLUSIONS: In this study of patients undergoing cranial dural repair, there was substantial variation in patient and procedural characteristics by selected intervention. Increasing complexity of case mix was associated with more resource intensive intervention and poorer outcomes, suggesting an unmet need for more effective means of dural tear repair.