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Updated: May 13, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
The association between race and frequent shunt failure: a single-center study
Robert P Naftel1, Nicole A Safiano, Michael Falola
1Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15224, USA. naftel@uab.edu
Insights
White race is the primary factor linked to frequent shunt failure in children with hydrocephalus. This disparity highlights the need for objective diagnostic criteria to ensure equitable care.
Area of Science:
- Pediatric Neurosurgery
- Health Services Research
- Clinical Epidemiology
Background:
- Frequent shunt failure in pediatric hydrocephalus leads to significant morbidity and healthcare utilization.
- Understanding demographic and socioeconomic factors is crucial for addressing disparities in shunt failure rates.
Purpose of the Study:
- To identify demographic and socioeconomic characteristics associated with frequent shunt failure in children with hydrocephalus.
- To investigate the independent contribution of race to shunt failure rates.
Main Methods:
- A survey collected demographic and socioeconomic data from 294 caregivers of children with shunt-treated hydrocephalus.
- Multivariate regression models were employed to analyze factors associated with frequent shunt failure (defined as ≥10 failures).
Main Results:
- White race was identified as the primary independent factor associated with frequent shunt failure (OR 5.8, p=0.027).
- Surgeon and years-with-shunt also remained associated with frequent shunt failure (p=0.043 and p=0.0098, respectively).
- Race was independent of socioeconomic and clinical factors, including hydrocephalus etiology.
Conclusions:
- White race is a significant independent predictor of frequent shunt failure in pediatric hydrocephalus.
- Subjectivity in shunt failure diagnosis may contribute to racial disparities in care.
- Objective diagnostic criteria are needed to mitigate disparities in shunt failure diagnosis and treatment.
Object:
Children experiencing frequent shunt failure consume medical resources and represent a disproportionate level of morbidity in hydrocephalus care. While biological causes of frequent shunt failure may exist, this study analyzed demographic and socioeconomic patient characteristics associated with frequent shunt failure.
Methods:
A survey of 294 caregivers of children with shunt-treated hydrocephalus provided demographic and socioeconomic characteristics. Children experiencing at least 10 shunt failures were considered frequent shunt-failure patients. Multivariate regression models were used to control for variables.
Results:
Frequent shunt failure was experienced by 9.5% of the patients (28 of 294). By univariate analysis, white race (p = 0.006), etiology of hydrocephalus (p = 0.022), years-with-shunt (p < 0.0001), and surgeon (p = 0.02) were associated with frequent shunt failure. Upon multivariate analysis, white race remained the key independent factor associated with frequent shunt failure (OR 5.8, 95% CI 1.2-27.8, p = 0.027). Race acted independently from socioeconomic factors, including income, level of education, and geographic location, and clinical factors, such as etiology of hydrocephalus, surgeon, and years-with-shunt. Additionally, after multivariate analysis surgeon and years-with-shunt remained associated with frequent shunt failure (p = 0.043 and p = 0.0098, respectively), although etiology of hydrocephalus was no longer associated (p = 0.1).
Conclusions:
White race was the primary independent factor associated with frequent shunt failure. Because races use health care differently and the diagnosis of shunt failure is often subjective, a disparity in diagnosis and treatment has arisen. These findings call for objective criteria for the preoperative and intraoperative diagnosis of shunt failure.
