Thirty-day outcomes of cerebrospinal fluid shunt surgery: data from the National Surgical Quality Improvement Program-Pediatrics

Piatt, Joseph H.

doi:10.3171/2014.5.peds1421

Cited by 51 publications

(34 citation statements)

References 35 publications

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“…Existing work demonstrates an overall 30-day shunt failure rate of approximately 13%; the current study expands on the existing work by analyzing patients undergoing an initial shunt placement separately from those undergoing a shunt revision, revealing a shunt failure rate of 8 and 14%, respectively [9,14]. Consistent with prior studies, patients undergoing a shunt revision were more likely to experience shunt failure than patients undergoing an initial VP shunt placement [9,14,15,16]. As the two groups are not directly comparable considering their significant preoperative differences, the present study also demonstrates that the factors predictive of shunt failure are different in both groups.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

et al. 2016

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Background: Ventriculoperitoneal (VP) shunt placement, the mainstay of treatment for hydrocephalus, can place a substantial burden on patients and health care systems because of high complication and revision rates. We aimed to identify factors associated with 30-day VP shunt failure in children undergoing either initial placement or revision. Methods: VP shunt placements performed on patients in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric were identified. Results: VP shunts were placed in 3,984 patients either as an initial placement (n = 1,093) or as a revision (n = 2,891). Compared to the initial-placement group, the revision group was significantly more likely to experience shunt failure (14 vs. 8%, p < 0.0001). In the initial-placement group, congenital hydrocephalus was independently associated with shunt failure (OR 1.83; 95% CI 1.01-3.31, p = 0.047). In the revision group, cardiac risk factors (OR 1.38; 95% CI 1.00-1.90, p = 0.047), a chronic history of seizures (OR 1.33; 95% CI 1.04-1.71, p = 0.022), and a history of neuromuscular disease (OR 0.61; 95% CI 0.41-0.90, p = 0.014) were independently associated with shunt failure. Conclusions: Identifying the factors associated with VP shunt failure may allow the development of interventions to decrease failures. Further refinement of the collected variables in the NSQIP Pediatric specific to neurosurgical procedures is necessary to identify modifiable risk factors.

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Section: Discussionmentioning

confidence: 99%

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

et al. 2016

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“…That younger patients are more vulnerable to implanted CNS hardware infections is not novel or surprising, and is consistent with many pediatric CSF shunt studies. 9,11 What is novel, however, is that the youngest group of children (less than 4 years of age) did not have the highest infection rate (8.6%) (Fig. 1).…”

Section: Patient Agementioning

confidence: 91%

Risk factors for baclofen pump infection in children: a multivariate analysis

Spader¹,

Bollo²,

Bowers³

et al. 2016

PED

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OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.

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“…This same group, as well as Dr. Goumnerova and colleagues at Boston Children's Hospital (http://www.qualityforum.org/QPS/0713), have advocated the use of the 30-day shunt malfunction rate. 35 The purpose of this study was to analyze in detail the etiologies of early shunt failure (within the first 90 days) in our population of pediatric patients with hydrocephalus and to determine the proportion of shunt failures that potentially could have been prevented. We believe that such detailed analysis is a requisite for the creation of any socalled quality metric within neurosurgery.…”

mentioning

confidence: 99%

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

Venable¹,

Rossi²,

Jones

et al. 2016

PED

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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.

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Thirty-day outcomes of cerebrospinal fluid shunt surgery: data from the National Surgical Quality Improvement Program-Pediatrics

Cited by 51 publications

References 35 publications

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision

Risk factors for baclofen pump infection in children: a multivariate analysis

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

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