Multiple shunt failures: an analysis of relevant factors

Lazareff, Jorge A.; Peacock, Warwick J.; Holly, Langston T.; Halen, Jon Ver; Wong, Aks; Olmstead, Charles E.

doi:10.1007/s003810050223

Cited by 97 publications

(82 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One third of all shunt failures are thought to be due to malfunction of the distal cathether which may be caused by dislocation or obstruction or migration into the anterior abdominal wall 8,20) . The distal failure rate may be higher in patients with abdominal adhesions, obesity, or scoliosis 17) .…”

Section: Discussionmentioning

confidence: 99%

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Park

et al. 2010

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Objective : Traditionally, peritoneal catheter is inserted with midline laparotomy incision in ventriculoperitoneal (V-P) shunt procedures. Complications of V-P shunt is not uncommon and have been reported to occur in 5-37% of cases. The aim of this study is to compare the clinical outcomes and the operation time between laparotomy and laparoscopic groups. Methods : A total of 155 V-P shunt procedures were performed to treat hydrocephalic patients of various origins in our institute between June 2006 to January 2010; 95 of which were laparoscopically guided and 65 were not. We reviewed the operation time, surgery-related complications, and intraoperative and postoperative problems. Results : In the laparoscopy group, the mean duration of the procedure (52 minutes) was significantly shorter (p < 0.001) than the laparotomy group (109 minutes). There were two cases of malfunctions and one incidence of diaphragm injury in the laparotomy group. In contrast, there were neither malfunction nor any internal organ injuries in the laparoscopy group (p = 0.034). There were total of two cases of infections from both groups (p = 0.7). Conclusion : Laparoscopically guided insertions of distal shunt catheter is considered a fast and safe method in contrast to the laparotomy technique. This method allows the exact localization of the peritoneal catheter and a confirmation of its patency.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Park

et al. 2010

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…As previously mentioned, prior research has identified several variables that appear to influence shunt survival, including a patient's age, number of prior revisions, and etiology of hydrocephalus; 5,6,10,19,21,25,34 however, the literature includes conflicting results on this topic, and several studies may indicate that shunt survival is impacted by one or more of these variables, while others do not. 4,6,10,19,21,25,34 Our study, unfortunately, has added to this confusing picture.…”

Section: Discussion Our Findingsmentioning

confidence: 99%

“…23 The identification of putative predictors of shunt survival has been an area of active research. 5,6,10,19,21,25,29,34 In the study by Berry et al, risk factors for shunt revision (initial and multiple) were young age, hospitals with lower shunt surgery volume, and type of hydrocephalus (e.g., obstructive and spina bifida). 4 Tuli et al found that age, time interval since last revision, and underlying diagnosis were predictors.…”

mentioning

confidence: 99%

“…The literature continues to evolve in identifying new potential risk factors, but is also inconsistent in that some studies identify variables that other studies refute. 4,6,10,19,21,25,34 Over the last decade-but particularly since passage of the Patient Protection and Affordable Care Act (PPACA) in 2010-there has been a tremendous focus placed on the creation, implementation, and evaluation of quality measurements or metrics, value, and so-called "pay-for-performance" in medicine. For example, in 2009 the Centers for Medicare and Medicaid Services began withholding payments for "reasonably preventable" conditions, such as certain hospital-acquired infections and pressure ulcers.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting shunt failure in children: should the global shunt revision rate be a quality measure?

Rossi

Khan

Jones

et al. 2016

PED

View full text Add to dashboard Cite

OBJECT Ventricular shunts for pediatric hydrocephalus continue to be plagued with high failure rates. Reported risk factors for shunt failure are inconsistent and controversial. The raw or global shunt revision rate has been the foundation of several proposed quality metrics. The authors undertook this study to determine risk factors for shunt revision within their own patient population. METHODS In this single-center retrospective cohort study, a database was created of all ventricular shunt operations performed at the authors’ institution from January 1, 2010, through December 2013. For each index shunt surgery, demographic, clinical, and procedural variables were assembled. An “index surgery” was defined as implantation of a new shunt or the revision or augmentation of an existing shunt system. Bivariate analyses were first performed to evaluate individual effects of each independent variable on shunt failure at 90 days and at 180 days. A final multivariate model was chosen for each outcome by using a backward model selection approach. RESULTS There were 466 patients in the study accounting for 739 unique (“index”) operations, for an average of 1.59 procedures per patient. The median age for the cohort at the time of the first shunt surgery was 5 years (range 0–35.7 years), with 53.9% males. The 90- and 180-day shunt failure rates were 24.1% and 29.9%, respectively. The authors found no variable—demographic, clinical, or procedural—that predicted shunt failure within 90 or 180 days. CONCLUSIONS In this study, none of the risk factors that were examined were statistically significant in determining shunt failure within 90 or 180 days. Given the negative findings and the fact that all other risk factors for shunt failure that have been proposed in the literature thus far are beyond the control of the surgeon (i.e., nonmodifiable), the use of an institution’s or individual’s global shunt revision rate remains questionable and needs further evaluation before being accepted as a quality metric.

show abstract

“…26 Many studies have sought to identify risk factors for shunt failure. 5,10,13,15,27,29,37,48 To date, there is no consensus within the literature on any clinical, demographic, or procedural variable as being predictive of shunt failure. We recently conducted our own institutional review of 739 shunt operations performed over a 4-year period and found no predictive risk factors for shunt failure within 90 and 180 days of surgery (de novo or revision).…”

mentioning

confidence: 99%

The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery

Venable¹,

Rossi²,

Jones

et al. 2016

PED

View full text Add to dashboard Cite

OBJECTIVE Shunt surgery consumes a large amount of pediatric neurosurgical health care resources. Although many studies have sought to identify risk factors for shunt failure, there is no consensus within the literature on variables that are predictive or protective. In this era of “quality outcome measures,” some authors have proposed various metrics to assess quality outcomes for shunt surgery. In this paper, the Preventable Shunt Revision Rate (PSRR) is proposed as a novel quality metric. METHODS An institutional shunt database was queried to identify all shunt surgeries performed from January 1, 2010, to December 31, 2014, at Le Bonheur Children's Hospital. Patients' records were reviewed for 90 days following each “index” shunt surgery to identify those patients who required a return to the operating room. Clinical, demographic, and radiological factors were reviewed for each index operation, and each failure was analyzed for potentially preventable causes. RESULTS During the study period, there were 927 de novo or revision shunt operations in 525 patients. A return to the operating room occurred 202 times within 90 days of shunt surgery in 927 index surgeries (21.8%). In 67 cases (33% of failures), the revision surgery was due to potentially preventable causes, defined as inaccurate proximal or distal catheter placement, infection, or inadequately secured or assembled shunt apparatus. Comparing cases in which failure was due to preventable causes and those in which it was due to nonpreventable causes showed that in cases in which failure was due to preventable causes, the patients were significantly younger (median 3.1 vs 6.7 years, p = 0.01) and the failure was more likely to occur within 30 days of the index surgery (80.6% vs 64.4% of cases, p = 0.02). The most common causes of preventable shunt failure were inaccurate proximal catheter placement (33 [49.3%] of 67 cases) and infection (28 [41.8%] of 67 cases). No variables were found to be predictive of preventable shunt failure with multivariate logistic regression. CONCLUSIONS With economic and governmental pressures to identify and implement “quality measures” for shunt surgery, pediatric neurosurgeons and hospital administrators must be careful to avoid linking all shunt revisions with “poor” or less-than-optimal quality care. To date, many of the purported risk factors for shunt failure and causes of shunt revision surgery are beyond the influence and control of the surgeon. We propose the PSRR as a specific, meaningful, measurable, and—hopefully—modifiable quality metric for shunt surgery in children.

show abstract

Multiple shunt failures: an analysis of relevant factors

Cited by 97 publications

References 14 publications

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Predicting shunt failure in children: should the global shunt revision rate be a quality measure?

The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery

Contact Info

Product

Resources

About