Factors Associated with Ventriculoperitoneal Shunt Failures in the First 30 Postoperative Days in Pediatric Patients.

Factors Associated with Ventriculoperitoneal Shunt Failures in the First 30 Postoperative Days in Pediatric Patients.

World Neurosurg. 2019 Jan 03;:

Authors: Orrego-González E, Enriquez-Marulanda A, Ravindran K, Celin-Varcalcel D, Parrado-Sánchez L, Lobato-Polo J

Abstract
OBJECTIVE: Ventriculoperitoneal shunts (VPS) are one of the most common procedures performed by neurosurgeons. Their surgical revision is a significant cause of patient morbidity and mortality. This study aimed to conduct an analysis of factors related to VPS failures in the first 30 postoperative days in a pediatric cohort.
MATERIAL AND METHODS: This was a retrospective cohort study of 83 pediatric patients (<18 years old), shunted for the first time at a referral care center, between January of 2012 and December of 2016. Univariate analysis was used to detect potential predictors of VPS failures within the first 30 postoperative days and in the first six months of follow-up. Kaplan-Meier survival curves were used to examine the occurrence of VPS failures over time.
RESULTS: During the first 30 postoperative days, VPS failures occurred in 21 (25.3%) patients. Intraventricular hemorrhage (IVH; OR: 4.41; CI 95%: 1.44 - 13.48), cerebrospinal fluid (CSF) alterations (OR: 5.11; CI 95%: 1.37 - 19.1), and previous external ventricular drain (EVD; OR: 7.05; CI 95%: 1.18 - 41.8), were significantly associated with shunt failure during the first postoperative month. Kaplan-Meier survival analysis showed decreased shunt survival for patients with IVH, both during the first 30 days after surgery (p=0.005, log-rank), and during the six months after surgery (p=0.005, log-rank).
CONCLUSIONS: In this study, we found that in pediatric patients, IVH was associated with VPS failure within the first 30 postoperative days and decreased shunt survival over time. Further prospective, larger and randomized studies are needed in order to better understand these results.

PMID: 30611949 [PubMed - as supplied by publisher]

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