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

Clinical article

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  • Division of Neurosurgery, Nemours Neuroscience Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware; and Department of Neurological Surgery and Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
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Object

Cerebrospinal fluid shunts are the mainstay of the treatment of hydrocephalus. In past studies, outcomes of shunt surgery have been analyzed based on follow-up of 1 year or longer. The goal of the current study is to characterize 30-day shunt outcomes, to identify clinical risk factors for shunt infection and failure, and to develop statistical models that might be used for risk stratification.

Methods

Data for 2012 were obtained from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) of the American College of Surgeons. Files with index surgical procedures for insertion or revision of a CSF shunt composed the study set. Returns to the operating room within 30 days for shunt infection and for shunt failure without infection were the study end points. Associations with a large number of potential clinical risk factors were analyzed on a univariate basis. Logistic regression was used for multivariate analysis.

Results

There were 1790 index surgical procedures analyzed. The overall rates of shunt infection and shunt failure without infection were 2.0% and 11.5%, respectively. Male sex, steroid use in the preceding 30 days, and nutritional support at the time of surgery were risk factors for shunt infection. Cardiac disease was a risk factor for shunt failure without infection, and initial shunt insertion, admission during the second quarter, and neuromuscular disease appeared to be protective. There was a weak association of increasing age with shunt failure without infection. Models based on these factors accounted for no more than 6% of observed variance. Construction of stable statistical models with internal validity for risk adjustment proved impossible.

Conclusions

The precision of the NSQIP-P dataset has allowed identification of risk factors for shunt infection and for shunt failure without infection that have not been documented previously. Thirty-day shunt outcomes may be useful quality metrics, possibly even without risk adjustment. Whether important variation in 30-day outcomes exists among institutions or among neurosurgeons is yet unknown.

Abbreviations used in this paper:CPT = Common Procedural Terminology; ICD-9 = International Classification of Diseases, Ninth Revision; NSQIP-P = National Surgical Quality Improvement Program-Pediatrics.

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Contributor Notes

Address correspondence to: Joseph H. Piatt Jr., M.D., Nemours Neuroscience Center, Division of Neurosurgery, 1600 Rockland Rd., Wilmington, DE 19803. email: jpiatt@nemours.org.

Please include this information when citing this paper: published online June 13, 2014; DOI: 10.3171/2014.5.PEDS1421.

  • 1

    Al-Tamimi YZ, , Sinha P, , Chumas PD, , Crimmins D, , Drake J, & Kestle J, : Ventriculoperitoneal shunt 30-day failure rate: a retrospective international cohort study. Neurosurgery 74:2934, 2014

    • Search Google Scholar
    • Export Citation
  • 2

    Caldarelli M, , Di Rocco C, & La Marca F: Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748754, 1996

    • Search Google Scholar
    • Export Citation
  • 3

    Chittiboina P, , Pasieka H, , Sonig A, , Bollam P, , Notarianni C, & Willis BK, : Posthemorrhagic hydrocephalus and shunts: what are the predictors of multiple revision surgeries? Clinical article. J Neurosurg Pediatr 11:3742, 2013

    • Search Google Scholar
    • Export Citation
  • 4

    Cochrane DD, & Kestle JR: The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38:295301, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Dallacasa P, , Dappozzo A, , Galassi E, , Sandri F, , Cocchi G, & Masi M: Cerebrospinal fluid shunt infections in infants. Childs Nerv Syst 11:643649, 1995

    • Search Google Scholar
    • Export Citation
  • 6

    Dillon P, , Hammermeister K, , Morrato E, , Kempe A, , Oldham K, & Moss L, : Developing a NSQIP module to measure outcomes in children's surgical care: opportunity and challenge. Semin Pediatr Surg 17:131140, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Drake JM, , Kestle JR, , Milner R, , Cinalli G, , Boop F, & Piatt J Jr, : Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294305, 1998

    • Search Google Scholar
    • Export Citation
  • 8

    Hanlo PW, , Cinalli G, , Vandertop WP, , Faber JA, , Bøgeskov L, & Børgesen SE, : Treatment of hydrocephalus determined by the European Orbis Sigma Valve II survey: a multicenter prospective 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99:5257, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Hatlen TJ, , Shurtleff DB, , Loeser JD, , Ojemann JG, , Avellino AM, & Ellenbogen RG: Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study. Clinical article. J Neurosurg Pediatr 9:462467, 2012

    • Search Google Scholar
    • Export Citation
  • 10

    Kestle J, , Drake J, , Milner R, , Sainte-Rose C, , Cinalli G, & Boop F, : Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33:230236, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Kestle JR, , Cochrane DD, & Drake JM: Shunt insertion in the summer: is it safe?. J Neurosurg 105:3 Suppl 165168, 2006

  • 12

    Kestle JR, , Drake JM, , Cochrane DD, , Milner R, , Walker ML, & Abbott R III, : Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98:284290, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Kestle JR, & Walker ML: A multicenter prospective cohort study of the Strata valve for the management of hydrocephalus in pediatric patients. J Neurosurg 102:2 Suppl 141145, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Kontny U, , Höfling B, , Gutjahr P, , Voth D, , Schwarz M, & Schmitt HJ: CSF shunt infections in children. Infection 21:8992, 1993

  • 15

    Kulkarni AV, , Drake JM, & Lamberti-Pasculli M: Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg 94:195201, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Kulkarni AV, , Riva-Cambrin J, , Butler J, , Browd SR, , Drake JM, & Holubkov R, : Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls. Clinical article. J Neurosurg Pediatr 12:334338, 2013

    • Search Google Scholar
    • Export Citation
  • 17

    Liptak GS, , Masiulis BS, & McDonald JV: Ventricular shunt survival in children with neural tube defects. Acta Neurochir (Wien) 74:113117, 1985

    • Search Google Scholar
    • Export Citation
  • 18

    McGirt MJ, , Buck DW II, , Sciubba D, , Woodworth GF, , Carson B, & Weingart J, : Adjustable vs set-pressure valves decrease the risk of proximal shunt obstruction in the treatment of pediatric hydrocephalus. Childs Nerv Syst 23:289295, 2007

    • Search Google Scholar
    • Export Citation
  • 19

    McGirt MJ, , Leveque JC, , Wellons JC III, , Villavicencio AT, , Hopkins JS, & Fuchs HE, : Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 36:248255, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    McGirt MJ, , Wellons JC III, , Nimjee SM, , Bulsara KR, , Fuchs HE, & George TM: Comparison of total versus partial revision of initial ventriculoperitoneal shunt failures. Pediatr Neurosurg 38:3440, 2003

    • Search Google Scholar
    • Export Citation
  • 21

    McGirt MJ, , Zaas A, , Fuchs HE, , George TM, , Kaye K, & Sexton DJ: Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858862, 2003

    • Search Google Scholar
    • Export Citation
  • 22

    Piatt JH Jr, & Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 19:233242, 1993

    • Search Google Scholar
    • Export Citation
  • 23

    Pollack IF, , Albright AL, & Adelson PD: A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery 45:13991411, 1999

    • Search Google Scholar
    • Export Citation
  • 24

    Sainte-Rose C, , Piatt JH, , Renier D, , Pierre-Kahn A, , Hirsch JF, & Hoffman HJ, : Mechanical complications in shunts. Pediatr Neurosurg 17:29, 1991–1992

    • Search Google Scholar
    • Export Citation
  • 25

    Shah SS, , Hall M, , Slonim AD, , Hornig GW, , Berry JG, & Sharma V: A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children. Neurosurgery 62:10951103, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Simon TD, , Hall M, , Riva-Cambrin J, , Albert JE, , Jeffries HE, & Lafleur B, : Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States. Clinical article. J Neurosurg Pediatr 4:156165, 2009

    • Search Google Scholar
    • Export Citation
  • 27

    Simon TD, , Whitlock KB, , Riva-Cambrin J, , Kestle JR, , Rosenfeld M, & Dean JM, : Association of intraventricular hemorrhage secondary to prematurity with cerebrospinal fluid shunt surgery in the first year following initial shunt placement. Clinical article. J Neurosurg Pediatr 9:5463, 2012

    • Search Google Scholar
    • Export Citation
  • 28

    Tuli S, , Drake J, & Lamberti-Pasculli M: Long-term outcome of hydrocephalus management in myelomeningoceles. Childs Nerv Syst 19:286291, 2003

    • Search Google Scholar
    • Export Citation
  • 29

    Tuli S, , Drake J, , Lawless J, , Wigg M, & Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:3138, 2000

    • Search Google Scholar
    • Export Citation

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