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Updated: Mar 30, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Predicting shunt failure in children: should the global shunt revision rate be a quality measure?
Nicholas B Rossi1, Nickalus R Khan1, Tamekia L Jones2
1Department of Neurosurgery, University of Tennessee Health Science Center;
Insights
This study found no significant risk factors for ventricular shunt failure in pediatric hydrocephalus patients within 180 days. Shunt revision rates may not be a reliable quality metric due to nonmodifiable factors.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Device Research
Background:
- Pediatric hydrocephalus treatment frequently involves ventricular shunts.
- High shunt failure rates necessitate frequent revisions, impacting patient outcomes.
- Existing risk factors for shunt failure are inconsistent and debated, complicating quality assessment.
Purpose of the Study:
- To identify demographic, clinical, and procedural risk factors for ventricular shunt failure in pediatric hydrocephalus.
- To evaluate the reliability of shunt revision rates as a quality metric.
Main Methods:
- A single-center retrospective cohort study analyzed 739 ventricular shunt operations from 2010-2013.
- Demographic, clinical, and procedural variables were collected for each index surgery.
- Bivariate and multivariate analyses assessed risk factors for shunt failure at 90 and 180 days.
Main Results:
- The study included 466 patients with a median age of 5 years at first shunt surgery.
- Ninety- and 180-day shunt failure rates were 24.1% and 29.9%, respectively.
- No demographic, clinical, or procedural variable significantly predicted shunt failure within 180 days.
Conclusions:
- No examined risk factors were statistically significant predictors of shunt failure within 180 days.
- The utility of global shunt revision rates as a quality metric is questionable.
- Further evaluation is needed before accepting shunt revision rates as a standard quality measure.
Object:
Ventricular shunts for pediatric hydrocephalus continue to be plagued with high failure rates. Reported risk factors for shunt failure are inconsistent and controversial. The raw or global shunt revision rate has been the foundation of several proposed quality metrics. The authors undertook this study to determine risk factors for shunt revision within their own patient population.
Methods:
In this single-center retrospective cohort study, a database was created of all ventricular shunt operations performed at the authors' institution from January 1, 2010, through December 2013. For each index shunt surgery, demographic, clinical, and procedural variables were assembled. An "index surgery" was defined as implantation of a new shunt or the revision or augmentation of an existing shunt system. Bivariate analyses were first performed to evaluate individual effects of each independent variable on shunt failure at 90 days and at 180 days. A final multivariate model was chosen for each outcome by using a backward model selection approach.
Results:
There were 466 patients in the study accounting for 739 unique ("index") operations, for an average of 1.59 procedures per patient. The median age for the cohort at the time of the first shunt surgery was 5 years (range 0-35.7 years), with 53.9% males. The 90- and 180-day shunt failure rates were 24.1% and 29.9%, respectively. The authors found no variable-demographic, clinical, or procedural-that predicted shunt failure within 90 or 180 days.
Conclusions:
In this study, none of the risk factors that were examined were statistically significant in determining shunt failure within 90 or 180 days. Given the negative findings and the fact that all other risk factors for shunt failure that have been proposed in the literature thus far are beyond the control of the surgeon (i.e., nonmodifiable), the use of an institution's or individual's global shunt revision rate remains questionable and needs further evaluation before being accepted as a quality metric.
