The Preventable Shunt Revision Rate: A Multicenter Evaluation

Pooja Dave, Garrett T. Venable, Tamekia L. Jones, Nickalus R. Khan, Gregory W. Albert, Joshua J. Chern, Jennifer L. Wheelus, Lance S. Governale, Kristin M. Huntoon, Cormac O. Maher, Amy K. Bruzek, Francesco T. Mangano, Vivek Mehta, Wendy Beaudoin, Robert P. Naftel, Jade Basem, Anna Whitney, Nir Shimony, Luis F. Rodriguez, Brandy N. VaughnPaul Klimo

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE: To evaluate the PSRR across multiple centers and determine associated variables. METHODS:Nine participating centers in NorthAmerica provided at least 2 years of consecutive shunt operations. Index surgery was defined as newshunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS: A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most commonetiologies of avoidable failurewere infection (n=134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.

Original languageEnglish (US)
Pages (from-to)788-797
Number of pages10
JournalClinical Neurosurgery
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

Keywords

  • Metrics
  • Multicenter
  • Preventable shunt revision rate
  • Quality
  • Shunt malfunction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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