(008) Early Ambulation Reduces Length of Stay after Middle Fossa Repair of Spontaneous Cerebrospinal Fluid Leaks

Introduction: Rates of spontaneous cerebrospinal fluid leaks (sCSFLs) requiring repair have increased approximately 10% annually for more than two decades, paralleling the obesity epidemic. Middle cranial fossa (MCF) craniotomy repair of lateral skull base (LSB) defects is a safe and durable technique, but prolonged postoperative hospitalization remains a common critique. This study evaluates the impact of an enhanced ambulation protocol on postoperative length of stay (LOS) and early (post‑operative day [POD] 1) discharge after MCF sCSFL repair.

Methods: Patients undergoing routine MCF repair of an encephalocele or sCSFL from 2018–2025 were retrospectively reviewed. The postoperative pathway included mobilization within 8–12 hours of extubation with the physician care team, postoperative CT of the internal auditory canal, and maintaining out‑of‑bed status during daylight hours following initial ambulation. Patients unable to participate in the standardized protocol due to comorbidities or functional limitations were excluded. LOS and POD 1 discharge rates were analyzed. Cost estimates used $3,000 per inpatient day. T‑tests were used for statistical comparison.

Results: A total of 144 patients underwent MCF craniotomy and LSB repair from 2018–2025. Between 2018–2020, 32 patients had an average (standard deviation) LOS of 2.3 (1.0) days, with no POD 1 discharges. In 2025, 33 patients had an average LOS of 1.3 (0.5) days (p < 0.0001), and 73% were discharged on POD 1. No increase in adverse events was observed.

Conclusions: A standardized postoperative pathway including early ambulation reduced LOS by 0.8 days (43%) and increased POD 1 discharge rates from 0% to 73%. Early mobilization and high‑volume center experience appear central to minimizing postoperative LOS. With an estimated $2,400 savings per patient, centers performing 25 annual cases may achieve approximately $60,000 in yearly system‑level savings.