Thirty-Day Hospital Readmission and Surgical Complication Rates for Shunting in Normal Pressure Hydrocephalus: A Large National Database Analysis

Abstract

BACKGROUND Research on age-related complications secondary to shunts in normal pressure hydrocephalus (NPH) is primarily limited to single-center studies and small cohorts. OBJECTIVE To determine the rates of hospital readmission and surgical complications, and factors that predict them, following shunt surgery for NPH in a large healthcare network. METHODS Surgical procedures, complications, and readmissions for adults undergoing ventricular shunting for NPH were determined using de-identified claims from a privately insured United States healthcare network in years 2007-2014. Univariate and multivariate statistics were used to determine factors that predict poor surgical outcomes. The primary outcome variable was surgical complications or readmissions (composite variable for any major perioperative complication or 30-d readmission). RESULTS The 30-d readmission rate for 974 patients with NPH who underwent ventricular shunting was 7.29%; the most common reasons for readmission were shunt-related complications, infection, hemorrhage, altered mental status, and cardiopulmonary and musculoskeletal problems. The perioperative complication rate was 21.15%, including intraparenchymal hemorrhage (5.85%) and extra-axial (subdural or epidural) hematoma (5.54%). The overall rate of having a surgical complication or 30-d readmission was 25.15%. Age did not predict surgical complication or 30-d readmission. Preoperative comorbidities independently associated with poor outcome were myocardial infarction within 1 yr (OR = 3.984, 95% CI = 1.105-14.368); existing cerebrovascular disease (odds ratio [OR] = 2.206, 95% CI = 1.544-3.152); and moderate/severe renal disease (OR = 2.000, 95% CI = 1.155-3.464). CONCLUSION The rate of complications or readmission within 30 d of ventricular shunting for NPH is 25.15%. Preoperative comorbidities of myocardial infarction within 1 yr, cerebrovascular disease, and moderate/severe renal disease are independent risk factors for poor outcome.

Impact of Comorbidities and Frailty on Early Shunt Failure in Geriatric Patients With Normal Pressure Hydrocephalus

“…VPS placement is the most established surgical treatment of NPH. Although published improvement rates after such surgery are high, some studies cautioned against a potentially significant complication rate (2)(3)(4). Therefore, great interest arises to identify possible factors that predict early VPS failure and postoperative complications.…”

“…Given an adequate preoperative patient selection, an improvement of preoperative symptoms might be expected in up to 90% of cases (2). There are numerous, but not yet conclusive studies on the predominant fundamental discussions on potentially suitable valves and pressure settings to positively influence the neurological outcome and avoid long-term complications (2)(3)(4)(5).…”

“…Despite its elective nature, VPS implantation is fraught with the risk of post-operative complications (infection, hygroma, under-, or overdrainage), which are reported to be as high as 38% (3,4). The potentially positive effect of VP shunt implantation may be negated by the reported increased post-operative complication rate.…”

Letter to the Editor: COVID-19 and the Neurosurgical Treatment of Idiopathic Normal Pressure Hydrocephalus: Shall We Continue to Postpone “Non-emergent” Surgical Procedures?

“…INPH patients usually do not need any post-operative intensive care unit assistance. 3 According to the international and local guidelines, INPH patients do not represent emergent neurosurgical procedures and our hydrocephalus clinic stopped all surgical and clinical activities during the lock-down phase. The European Association of Neurosurgical Societies advises triages of neurosurgical procedures based on an emergency tier classification based on the American College of Surgeons and Elective Surgery Acuity Scale from St. Louis University, but we could not find any recommendation regarding INPH patients.…”

Improving outcomes and decreasing costs of neurological diseases: Mind the gap

“…They compared moving from the 25% of patients who undergo surgery nowadays to an ambitious target of 90%. Timely and adequate shunting was cost‐effective, with a cost per QALY saved of €20,202 at 5 years and €35,128 at 15 years, although 15 years is an optimistic length of survival, considering the median age and comorbidities of idiopathic NPH patients [7,9].…”