A Multicenter Study of Factors Influencing Cerebrospinal Fluid Shunt Survival in Infants and Children

Shah, Samir S.; Hall, Matthew; Slonim, Anthony D.; Hornig, Gregory W.; Berry, Jay G.; Sharma, Vidya

doi:10.1227/01.neu.0000325871.60129.23

Cited by 70 publications

(45 citation statements)

References 23 publications

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“…Existing work demonstrates an overall 30-day shunt failure rate of approximately 13%; the current study expands on the existing work by analyzing patients undergoing an initial shunt placement separately from those undergoing a shunt revision, revealing a shunt failure rate of 8 and 14%, respectively [9,14]. Consistent with prior studies, patients undergoing a shunt revision were more likely to experience shunt failure than patients undergoing an initial VP shunt placement [9,14,15,16]. As the two groups are not directly comparable considering their significant preoperative differences, the present study also demonstrates that the factors predictive of shunt failure are different in both groups.…”

Section: Discussionsupporting

confidence: 70%

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

et al. 2016

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Background: Ventriculoperitoneal (VP) shunt placement, the mainstay of treatment for hydrocephalus, can place a substantial burden on patients and health care systems because of high complication and revision rates. We aimed to identify factors associated with 30-day VP shunt failure in children undergoing either initial placement or revision. Methods: VP shunt placements performed on patients in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric were identified. Results: VP shunts were placed in 3,984 patients either as an initial placement (n = 1,093) or as a revision (n = 2,891). Compared to the initial-placement group, the revision group was significantly more likely to experience shunt failure (14 vs. 8%, p < 0.0001). In the initial-placement group, congenital hydrocephalus was independently associated with shunt failure (OR 1.83; 95% CI 1.01-3.31, p = 0.047). In the revision group, cardiac risk factors (OR 1.38; 95% CI 1.00-1.90, p = 0.047), a chronic history of seizures (OR 1.33; 95% CI 1.04-1.71, p = 0.022), and a history of neuromuscular disease (OR 0.61; 95% CI 0.41-0.90, p = 0.014) were independently associated with shunt failure. Conclusions: Identifying the factors associated with VP shunt failure may allow the development of interventions to decrease failures. Further refinement of the collected variables in the NSQIP Pediatric specific to neurosurgical procedures is necessary to identify modifiable risk factors.

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Section: Discussionsupporting

confidence: 70%

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

et al. 2016

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“…Reinprecht et al [8] described an incidence of obstruction of 41% in the first year in a series of 42 preterm infants with posthaemorrhagic hydrocephalus. Other studies have shown similar results, albeit most large series are not restricted to preterm-related posthaemorrhagic hydrocephalus [1,2,3,4,5,6,7]. The differences observed in our series may be due to the fact that no cases were classified as obstruction if either disconnection or infection of the shunt was present at the same time.…”

Section: Discussionsupporting

confidence: 72%

“…The overall incidence of shunt obstruction in patients with hydrocephalus is estimated to be around 40% during the first year and increases to affect nearly 50% of patients by the second year after shunt implantation [1,2]. Long-term follow-up data available from the Shunt Design Trial show that only 41% of shunts remain free of obstruction after 4 years of follow-up [3].…”

Section: Introductionmentioning

confidence: 99%

Initial Proximal Obstruction of Ventriculoperitoneal Shunt in Patients with Preterm-Related Posthaemorrhagic Hydrocephalus

Miranda¹,

Simal²,

Menor

et al. 2011

Pediatr Neurosurg

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Background/Aims: Obstruction is the most common complication of ventriculoperitoneal shunts in patients with hydrocephalus. Despite technical advances, rates of obstruction have barely decreased and remain at over 40% of cases. Patients suffering from preterm-related posthaemorrhagic hydrocephalus are considered a group with a particularly high risk of obstruction. The aim of the present study was to review our series of patients with preterm-related posthaemorrhagic hydrocephalus and analyse the occurrence of the first ventricular shunt obstruction as well as the related clinical and radiological factors. Methods: We conducted a retrospective review of 103 cases treated from 1982 to 2010. Descriptive analysis, raw and adjusted bivariate correlations and survival analysis were performed. Results: Over the course of the follow-up, 42 patients presented at least one episode of obstruction that required proximal revision. Medium-opening pressure valves were associated with a higher rate of obstruction compared to low-opening pressure valves; however, in our series this association became statistically significant only in patients with a weight of over 2,000 g at the time of surgery (odds ratio 6.75). The occurrence of previous infection and the development of late slit ventricle syndrome were also significantly associated with obstruction of the ventricular catheter (odds ratios 3.35 and 4.27, respectively). Conclusions: Rates of shunt obstruction in preterm-related posthaemorrhagic hydrocephalus remain high but do not seem to be higher than in other groups of paediatric hydrocephalus. Prevention of infection and the use of the appropriate type of valve design can help to decrease the incidence of proximal shunt obstruction, which in turn could decrease the incidence of symptomatic slit ventricle syndromes.

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“…Low age or prematurity have been found to be significant risk factors for shunt failure in previous studies, with HR in a narrow range of 2.02–2.49, compared to 2.05 in the present study (table 2) [4,5,13]. One previous study has found another concurrent procedure to be a risk factor with an HR of 1.77, similar to what we found (2.07), whereas McGirt et al [14], analysing 820 VPS procedures, found use of the endoscope to be a risk factor for shunt infection (RR = 1.58) [5,14].…”

Section: Discussionmentioning

confidence: 40%

“…As a concurrent procedure prolongs the duration of surgery, the finding that long duration of surgery was found to be a risk factor for shunt failure (HR = 1.23 with every 30-min increase in time) may reflect this. Other risk factors previously studied include short time between revisions, aetiology of myelomeningocele and high number of previous shunts [5,13]. As we only studied first-time shunts, we have no data on risk factors involving revisions, as for aetiology as a risk factor, our population was too small to allow any conclusions.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome after Treatment of Hydrocephalus in Children

et al. 2010

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Aims: To provide long-term outcome data after treatment of hydrocephalus in children, and to identify risk factors for ventriculoperitoneal shunt (VPS) failure. Methods: Endoscopic third ventriculostomy (ETV) and VPS procedures in children between 2001 and 2005 were reviewed. Data collected prospectively included age at surgery, sex, aetiology of hydrocephalus, gestational age, emergency/planned surgery, duration of surgery, time of day, surgeon’s experience and other concomitant surgery. The mean follow-up was 4.7 years (min. 2 years). The endpoint was a new surgery due to failure of treatment, and the time to failure was noted. Risk factors for VPS failure were analysed by univariate Cox proportional hazards regression. Results: Ninety-eight patients were included, 76 with a VPS, 22 with an ETV. Fifty-five percent of ETV and 58% of VPS failed. Significant risk factors (p < 0.05) for VPS failure were prematurity (HR: 2.05; 95% CI: 1.12–3.76), concomitant procedure (HR: 2.07; 95% CI: 1.04–4.12) and long duration of surgery (HR: 1.23; 95% CI: 1.06–1.44), while sex, surgeon’s experience, shunt type, at what department the surgery was performed, whether the surgery was acute or elective, and time of day were not. Conclusion: Treatment failure occurred in >50% of patients after ETV and VPS. Prematurity and concomitant surgery were major risk factors for VPS failure.

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A Multicenter Study of Factors Influencing Cerebrospinal Fluid Shunt Survival in Infants and Children

Abstract: Regional variation in the risk of ventricular shunt revision exists, and young infants are at the highest risk for shunt failure. Risk factors for the duration of shunt survival differ between the initial and subsequent revisions.

Cited by 70 publications

References 23 publications

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

Initial Proximal Obstruction of Ventriculoperitoneal Shunt in Patients with Preterm-Related Posthaemorrhagic Hydrocephalus

Long-Term Outcome after Treatment of Hydrocephalus in Children

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