Revision and complication rates in adult shunt surgery: a single-institution study

Abstract

Background CSF diversion with shunt placement is frequently associated with need for later revisions as well as surgical complications. We sought to review revision and complication rates following ventriculoperitoneal, ventriculoatrial and cystoperitoneal shunt placement in adult patients, and to identify potential risk factors for revision surgery and postoperative complications. Method Included patients were adults (≥ 18 years) who underwent primary shunt insertion at St. Olavs Hospital in Trondheim, Norway, from 2008 through 2017. The electronic medical records and diagnostic imaging from all hospitals in our catchment area were retrospectively reviewed. Follow-up ranged from 1 to 11 years. Complications were graded according to the Landriel Ibañez classification system. Results Of the 227 patients included, 47 patients (20.7%) required revision surgery during the follow-up. In total, 90 revision surgeries were performed during follow-up. The most common cause for the first revision was infection (5.7%) and for all revisions proximal occlusion (30.0%). A total of 103 patients (45.4%) experienced ≥ 1 complication(s). Mild to moderate complications (grade I and II) were detected in 35.0% of all procedures. Severe or fatal complications (grade III and IV) were observed in 8.2% of all procedures. Urinary tract infections and pneumonia were common postoperatively (13.9% and 7.3%, respectively), and the most common IIb complication was shunt misplacement (proximally or distally). Two out of fourteen deaths within 30 days were directly associated with surgery. We did not find that aetiology/indication, age or gender influenced the occurrence of revision surgery or a grade III or IV complication. Conclusions Shunt surgery continues to be a challenge both in terms of revision rates and procedure-related complications. However, the prediction of patients at risk remains difficult. A multidimensional focus is probably needed to reduce risks.

Shunt complications and revisions in children: A retrospective single institution study

“…Revision surgery occurred most commonly within one year, findings similarly reported by others (Mansoor et al, 2020;Merkler et al, 2017;Stein & Guo, 2008). However, revision surgery also occurred after 8 years in the current study.…”

“…We also detected other complications, such as extracranial infections, local wound infections, one instance of respiratory failure, and one recurrent laryngeal nerve paresis in relation to intubation. Similarly, we have found a high frequency of extracranial complications in an adult population (Mansoor et al., 2020 ). In all likelihood, extracranial complications represent significant morbidity with increased length of hospital stay.…”

“…In the literature, complications rates are often limited to revision rates as a measure of shunt failure or success. However, in an adult population, we found that complications extend beyond revision surgeries alone, with overall 30‐day complication rates of 45% in a cohort with 20.7% revision rates (Mansoor et al., 2020 ). We believe that reporting revision rates alone might represent a great underrepresentation of the actual challenges hydrocephalic patients face.…”

Experiences of family caregivers of patients with post-traumatic hydrocephalus from hospital to home: a qualitative study

“…Considering the shortened average length of hospital stay, and high hospitalization expenses under the healthcare policy, patients and their relatives choose to go home to recover after the acute stage of surgical treatment [ 19 , 20 ], if there is no postoperative infection in shunt patients, the function of the shunt device was determined by clinical presentation and imaging, and patients and caregivers were usually discharged within two weeks postoperatively [ 16 ]. The transition of care from hospital to home, when patients are discharged but have not yet recovered, is a critical and vulnerable period for caregivers and patients [ 21 ].…”

Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

“…[1][2][3][4] A variety of complications are known to occurs after the VPS insertion, and many of them require VPS revisions. [5][6][7][8] Perforation of the abdominal hollow viscera and extrusion of the distal VPS catheter through the natural orifices is also a known complication. Extrusion of the distal VPS catheter through the anal canal is the commonest, followed by the trans-urethra extrusion, trans-oral extrusion, and trans-vaginal extrusions.…”