Prevalence, Causes and Early Outcomes of Shunt Revisions at a Tertiary Hospital in Tanzania

Abstract

BACKGROUND The mainstay treatment for patients presenting with hydrocephalus is surgical, with VPS placement being a routine practice, especially in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident compounding to significant patient morbidity and mortality.METHODS This study was carried out at a tertiary hospital between March 2020 and March 2023. It includes 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for three months, at which time their characteristics in relation to shunt complications were evaluated. The SPSS version 26 was utilized for analyzing the data that had been gathered.RESULTS VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. The majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). SSI increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 minutes. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating to longer hospital stays.CONCLUSION The emphasis on long surgery durations and a surgeon's skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice from the index operation be enhanced to reduce complications. The findings of this study might serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.