2026 Poster Presentations
P254: A RETROSPECTIVE ANALYSIS OF PATIENT-LEVEL AND NEIGHBORHOOD-LEVEL BARRIERS IN PATIENTS UNDERGOING CSF LEAK REPAIR
Nadine M Javier, BS; Manick Saran, DO; Gabriela Guevara, MPH; Roy Casiano, MD; David Lerner, MD; Zoukaa Sargi, MD, MPH; Ruixuan Ma, MS; Corinna Levine, MD, MPH; University of Miami Miller School of Medicine
Background: Cerebrospinal fluid (CSF) leaks result from a breach in the dura mater. Idiopathic leaks comprise 10–20% of cases. Delayed diagnosis increases the risk of serious complications, including meningitis. Despite the need for timely intervention, many patients experience significant delays in receiving appropriate care, including surgical repair. Barriers associated with delays in care in the medical literature include diagnostic delays, language barriers, transportation, and high out-of-pocket costs. These challenges—stemming from individual or neighborhood-level factors—can prolong symptom duration, reduce adherence to post-operative care, increase loss to follow-up, and raise the risk of recurrence. It is unclear how these care barriers impact CSF leak diagnosis and contribute to delays in care. This study aims to assess the role of disease features, surgical repair, patient-level, and neighborhood-level factors on idiopathic CSF leak symptom duration and CSF leak recurrence.
Methods: We conducted an IRB-approved exploratory retrospective cohort study of patients 15-90 years old who had idiopathic CSF leak repair from 1/2015-7/2025 at a tertiary academic center. Subjects with CSF leak from trauma or tumor were excluded. Primary independent variables were CSF leak symptom duration, loss to follow-up, and recurrent CSF leak. Primary dependent variables include patient-level (education, income, language, literacy, distance traveled, insurance payer) and neighborhood-level (social vulnerability index (SVI), public transit access, and neighborhood crime rates). Data on demographics, confounders, surgical characteristics, and outcomes were reviewed.
The following cohorts were compared: (1) subjects with <=3months; (2) >3-18months; (3) >18 months of CSF leak symptoms. Separately, we compared factors associated with/without recurrent CSF leak and adherent/lost to follow-up. Univariable analysis used to evaluate for associations, followed by use of multivariable linear regression model. Continuous data was compared between two groups using the Wilcoxon rank sum test and more than two groups using the Kruskal-Wallis test. Categorical variables were compared using Pearson’s chi-squared test or Fisher’s exact test. Statistical significance was considered p<0.05.
Results: The study included 49 subjects mean age 56 years (Sd=11), 78% female, 61% White, 37% Black, 47% Hispanic, 35% primary language Spanish, 88% private insurance. Higher proportion of females in those with symptoms >3-18 months.
Comparing CSF leak duration, we found that larger defect sizes (p=0.012), heavier weight (p=0.034) were associated with CSF leak symptoms >18 months compared with <=3 months and >3-18 months. Subjects with recurrent CSF leak had higher lumbar drain use in the preoperative period (p=0.011), higher rates of pre-op meningitis (p=0.031), and higher incidence of encephaloceles prior to surgery (p=0.003). Weight and weight loss over 1-year post-op were not associated with the risk of recurrent CSF leak. Neighborhood crime score, SVI, and a higher proportion of Medicare insurance were present in those with >18 months of CSF leak symptoms as compared to shorter symptom duration, but did not reach statistical significance.
Conclusion: Longer symptom duration and recurrent CSF leaks were associated with larger defect sizes and increased perioperative risk factors. Although patient-level sociodemographic and neighborhood-level factors showed suggestive trends, they did not reach statistical significance, highlighting the need for more granular investigation in a larger cohort.