Related Experiment Video
Updated: Jul 6, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children
Jay G Berry1, Matthew A Hall, Vidya Sharma
1Department of Medicine, Complex Care Service, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. jay.berry@childrens.harvard.edu
Insights
Children needing cerebrospinal fluid shunt revisions often require multiple procedures. Higher hospital volume for initial shunt placement is linked to fewer revisions, suggesting process improvements may reduce shunt failures.
Area of Science:
- Pediatric Neurosurgery
- Health Services Research
- Medical Device Outcomes
Background:
- Cerebrospinal fluid (CSF) shunts are critical for managing hydrocephalus in children.
- Shunt revisions are common and associated with significant morbidity.
- Understanding factors influencing shunt revision rates is essential for improving patient care.
Purpose of the Study:
- To identify risk factors and predictors for cerebrospinal ventricular shunt revisions in pediatric patients.
- To analyze the impact of hospital volume and geographic factors on shunt revision rates.
Main Methods:
- Retrospective longitudinal cohort study of 1307 children (ages 0-18) undergoing initial ventricular shunt placement.
- Data collected from 32 children's hospitals using the Pediatric Health Information Systems database (2000-2005).
- Bivariate and multivariate regression analyses were used to compare revision rates with patient and hospital characteristics, accounting for hospital clustering.
Main Results:
- 37% of children required at least one shunt revision within 5 years; 20% required two or more.
- Institutional shunt revision rates varied widely (20-70%).
- Hospitals with higher initial shunt placement volume (>83/year) had lower revision rates (22%) compared to low-volume hospitals (42%). Children in the Midwest showed higher odds of multiple revisions (OR 1.25).
Conclusions:
- Higher hospital volume for initial shunt placement is associated with significantly lower rates of revision.
- Considerable variation in shunt revision rates exists across children's hospitals, indicating potential for process optimization.
- Further prospective research is needed to elucidate the specific reasons for inter-hospital variability in shunt revision rates.
Objective:
To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children.
Methods:
A retrospective, longitudinal cohort of 1307 children ages 0 to 18 years undergoing initial ventricular shunt placement in the year 2000, with follow-up through 2005, from 32 freestanding children's hospitals within the Pediatric Health Information Systems database was studied. Rates of ventricular shunt revision were compared with patient demographic, clinical, and hospital characteristics with use of bivariate and multivariate regression accounting for hospital clustering.
Results:
Thirty-seven percent of children required at least one shunt revision within 5 years of initial shunt placement; 20% of children required two or more revisions. Institutional rates of first shunt revision ranged from 20 to 70% of initial shunts placed among the 32 hospitals in the cohort. Hospitals where one to 20 initial shunt placements per year experienced the highest initial shunt revision rate (42%). Hospitals performing over 83 initial shunt placements per year experienced the lowest revision rate (22%). We found that children undergoing shunt placement in the Midwest were more likely to experience multiple shunt revisions (odds ratio, 1.25; 95% confidence interval, 1.06-1.47) after controlling for hospital volume, shunt type, age, and diagnosis associated with initial shunt placement.
Conclusion:
Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.
