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

Dani O. Gonzalez, Justin B. Mahida, Lindsey Asti, Erica J. Ambeba, Brian Kenney, Lance Governale, Katherine J. Deans, Peter C. Minneci

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)6-12
Number of pages7
JournalPediatric Neurosurgery
Volume52
Issue number1
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Ventriculoperitoneal Shunt
Hydrocephalus
Quality Improvement
Pediatrics
Neurosurgical Procedures
Neuromuscular Diseases
Patient Care
Seizures
Delivery of Health Care

Keywords

  • Children
  • National Surgical Quality Improvement Program Pediatric
  • Ventriculoperitoneal shunt failure

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

Cite this

Gonzalez, D. O., Mahida, J. B., Asti, L., Ambeba, E. J., Kenney, B., Governale, L., ... Minneci, P. C. (2016). Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. Pediatric Neurosurgery, 52(1), 6-12. https://doi.org/10.1159/000447410

Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. / Gonzalez, Dani O.; Mahida, Justin B.; Asti, Lindsey; Ambeba, Erica J.; Kenney, Brian; Governale, Lance; Deans, Katherine J.; Minneci, Peter C.

In: Pediatric Neurosurgery, Vol. 52, No. 1, 01.11.2016, p. 6-12.

Research output: Contribution to journalArticle

Gonzalez, DO, Mahida, JB, Asti, L, Ambeba, EJ, Kenney, B, Governale, L, Deans, KJ & Minneci, PC 2016, 'Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision', Pediatric Neurosurgery, vol. 52, no. 1, pp. 6-12. https://doi.org/10.1159/000447410
Gonzalez, Dani O. ; Mahida, Justin B. ; Asti, Lindsey ; Ambeba, Erica J. ; Kenney, Brian ; Governale, Lance ; Deans, Katherine J. ; Minneci, Peter C. / Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. In: Pediatric Neurosurgery. 2016 ; Vol. 52, No. 1. pp. 6-12.
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abstract = "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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AU - Deans, Katherine J.

AU - Minneci, Peter C.

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AB - 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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