Evaluation of Risk of Gastrostomy and Ventriculoperitoneal Shunt Placement in Pediatric Patients: A Systematic Review of the Literature

Gerges, Christina; Wijesekera, Olindi; Herring, Eric; Adesina, Adeleso; Wright, Christina Huang; Woodard, Joslyn I.; Stout, Amber; Rothstein, Brian; Selden, Nathan R.; Wright, James

doi:10.1016/j.wneu.2021.05.044

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…The data on an ideal interval and sequence of gastrostomy and VPS placement to mitigate the risks of infection and revision are mixed and inconclusive for the adult population. [9][10][11][12][13]15,16,21 Perhaps the most notable study was conducted recently in 2022 by Hallan and Rizk. 16 Using a multi-institutional database (TriNetX), they evaluated 4269 patients categorized into cohorts of patients with varying procedure intervals.…”

Section: Discussionmentioning

confidence: 99%

Gastrostomy Sequence With Ventriculoperitoneal Shunting—Does It Matter?

et al. 2023

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BACKGROUND: Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy. OBJECTIVE: To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults. METHODS: In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting. RESULTS: In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates. CONCLUSION: Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.

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Section: Discussionmentioning

confidence: 99%

Gastrostomy Sequence With Ventriculoperitoneal Shunting—Does It Matter?

et al. 2023

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“…A 2021 systematic review of G-tube and VPS placement in the pediatric population by Gerges et al found four studies involving the timing of VPS and G-tube placement, which reported inconclusive results, with some study patients having no infections with the concomitant placement of both devices, and other studies showing increased risk of shunt infection with prior G-tube placement [ 11 - 15 ].…”

Section: Discussionmentioning

confidence: 99%

Ventriculoperitoneal Shunt and Gastrostomy Tube Placement and Timing: A Database Analysis

Hallan¹,

Rizk²

2022

Cureus

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Background Debate exists about the safety of ventriculoperitoneal shunt placement in the presence of a gastrostomy tube and the timing of these procedures from each other. Using a large database, we sought to determine the rates of shunt infection and revision in patients who had both devices placed, based on the timing between procedures. Methods We performed a retrospective database analysis using a multi-institutional database (TriNetX), looking at all patients diagnosed with gastrostomy tube with subsequent ventriculoperitoneal shunt placement and vice-versa. We also evaluated patients who had gastrostomy tubes and shunts placed at the same time. We categorized cohorts into patients with device placement after 1-10 days, 11-30 days, and after one month of the other. Our primary endpoints were shunt infection and shunt revision. Results Patients who had same-day gastrostomy tube and shunt placement had a shunt infection rate of 10.06% within five years, and 14.53% had a shunt revision. With prior shunting and subsequent gastrostomy tube placement within 1-10 days, 12.18% had shunt infections, and 17.88% had shunt revisions; for those who had subsequent gastrostomy tube placement within 11-30 days, shunt infections were seen in 10.57%, and shunt revisions in 19.41%; gastrostomy tube placement after one month or longer of shunt placement resulted in 15.39% of patients having shunt infections and 17.73% with shunt revision. Prior gastrostomy tube patients with subsequent shunt placement, within 1-10 days had shunt infection rates of 8.27% and revision rates of 14.39%; for shunt placement within 11-30 days, shunt infections were seen in 10.82%, and shunt revisions were done in 14.33% of patients; for shunt placement after one month or longer, shunt infection rate was 11.68%, and revision rate was 16.80%. Conclusions Our results demonstrate no significant difference in shunt infection rates and shunt revision rates between same-day gastrostomy tube and shunt placement versus placement within 1-10 days, 11-30 days, or any time after one month from one another.

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Central Nervous System Infections and Their Management

Leclair

Hersh

2023

Pediatric Neurosurgery Board Review

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Evaluation of Risk of Gastrostomy and Ventriculoperitoneal Shunt Placement in Pediatric Patients: A Systematic Review of the Literature

Cited by 4 publications

References 30 publications

Gastrostomy Sequence With Ventriculoperitoneal Shunting—Does It Matter?

Gastrostomy Sequence With Ventriculoperitoneal Shunting—Does It Matter?

Ventriculoperitoneal Shunt and Gastrostomy Tube Placement and Timing: A Database Analysis

Central Nervous System Infections and Their Management

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