Quality control approach to cerebrospinal fluid leaks.

Cerebrospinal fluid (CSF) leaks are one of the most common complications of endoscopic sinus and skull base surgery, and are associated with significant morbidity and cost. A quality improvement program can be designed for individual surgeons or groups of surgeons to monitor outcomes and implement changes to decrease the risk of a postoperative CSF leak. Analytic tools include a root cause analysis, statistical analysis of risk factors, and predictive modeling. Monitoring of outcomes is accomplished with a time series plot or run chart. A circular action loop for assessing and implementing changes facilitates incremental progress and creates a learning culture for the institution.