Analysis of shunted hydrocephalus follow-up: What do routine clinic visits yield? What factors affect revision surgery presentation and outcomes?

Rubino, Sebastian; Gabbireddy, Sairisheel R.; Altshuler, Jake; Talwar, Ankoor A.; Feustel, Paul J.; Adamo, Matthew A.

doi:10.1016/j.jocn.2020.10.047

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Elective procedures may be associated with fewer shunt complications due to decreased severity of shunt failure symptoms. This is consistent with the prior literature, indicating that routine clinic visits after shunt placement yields better outcomes and lower the rates of revision surgery [ 33 ]. Conversely, patients who present with acute symptoms of shunt malfunction often undergo urgent shunt revision surgery.…”

Section: Discussionsupporting

confidence: 92%

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Shahrestani¹,

Shlobin²,

Gendreau³

et al. 2023

Pediatr Neurosurg

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Introduction Hydrocephalus is a common pediatric neurosurgical pathology typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the present study to validate a predictive model of pediatric shunt complications with data retrieved from the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD). Methods The HCUP NRD was queried from 2016 to 2017 for pediatric patients undergoing shunt placement using ICD-10 codes. Comorbidities present upon initial admission resulting in shunt placement, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) at admission classifications were obtained. The database was divided into training (n=19,948), validation (n=6,650), and testing (n=6,650) datasets. Multivariable analysis was performed to identify significant predictors of shunt complications which were used to develop logistic regression models. Post-hoc receiver operating characteristic (ROC) curves were created. Results A total of 33,248 pediatric patients aged 6.9±5.7 years were included. Number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04-1.07) and initial neurological admission diagnoses (OR: 3.83, 95% CI: 3.33-4.42) positively correlated with shunt complications. Female sex (OR: 0.87, 95%CI: 0.76-0.99) and elective admissions (OR: 0.62, 95%CI: 0.53-0.72) negatively correlated with shunt complications. ROC curve for the regression model utilizing all significant predictors of readmission demonstrated area under the curve (AUC) of 0.733, suggesting these factors are possible predictors of shunt complications in pediatric hydrocephalus. Conclusion Efficacious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm delineated possible variables predictive of shunt complications with good predictive value.

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Section: Discussionsupporting

confidence: 92%

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Shahrestani¹,

Shlobin²,

Gendreau³

et al. 2023

Pediatr Neurosurg

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Pediatric shunt failure in a resource limited Lower-Middle Income Country (LMIC) institution in La Paz, Bolivia

Lu,

Brun,

Niazi

et al. 2024

Childs Nerv Syst

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Hydrocephalus in Spina Bifida

et al. 2021

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Hydrocephalus is the most important co-morbidity in myelomeningocele from a neurosurgical perspective. Historically, 75-80% of patients with myelomeningocele have required treatment with a shunt but recent advances including intra-uterine myelomeningocele closure and ETV-CPC are reducing this burden. The expression of hydrocephalus differs between patients and across the life span. Hydrocephalus impacts the clinical expression of other important co-morbidities including the Chiari II malformation and tethered spinal cord. Shunt failure is often the key stress to prompt symptomatic worsening of these other conditions. Shunt failure may occur with minimal ventricular change on CT or MRI in Spina Bifida patients. Waiting for radiographic changes in symptomatic SB patients with shunts may result in hydrocephalus related fatalities. It is hypothesized but not proven that shunt failure may contribute to respiratory insufficiency and be a risk factor for sudden death in adult patients with spina bifida. Excellence in hydrocephalus management in MMC is essential for proper care, good outcomes, and quality of life for patients and families.

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Analysis of shunted hydrocephalus follow-up: What do routine clinic visits yield? What factors affect revision surgery presentation and outcomes?

Cited by 3 publications

References 14 publications

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Pediatric shunt failure in a resource limited Lower-Middle Income Country (LMIC) institution in La Paz, Bolivia

Hydrocephalus in Spina Bifida

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