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Updated: Mar 16, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision
Dani O Gonzalez1, Justin B Mahida, Lindsey Asti
1Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Ventriculoperitoneal (VP) shunt revisions are more likely to fail within 30 days than initial placements. Factors like congenital hydrocephalus, cardiac issues, seizures, and neuromuscular disease influence VP shunt failure rates in children.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Health Services Research
Background:
- Ventriculoperitoneal (VP) shunts are primary treatments for hydrocephalus.
- High complication and revision rates for VP shunts present significant patient and healthcare burdens.
- Understanding factors predicting short-term VP shunt failure is crucial for improving outcomes.
Purpose of the Study:
- To identify factors associated with 30-day VP shunt failure in pediatric patients.
- To compare failure rates between initial VP shunt placements and revisions.
Main Methods:
- Analysis of VP shunt placements from the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database.
- Inclusion of both initial shunt placements and revision surgeries.
- Statistical analysis to identify independent predictors of 30-day shunt failure.
Main Results:
- VP shunt revision surgery had a significantly higher 30-day failure rate (14%) compared to initial placements (8%).
- In the initial placement group, congenital hydrocephalus was linked to increased shunt failure.
- In the revision group, cardiac risk factors, chronic seizures, and neuromuscular disease history were associated with shunt failure.
Conclusions:
- Identifying specific risk factors for VP shunt failure can guide the development of targeted interventions.
- Further refinement of neurosurgical variables within the NSQIP Pediatric database is needed to pinpoint modifiable risk factors.
- Reducing VP shunt failure rates can alleviate patient and healthcare system burdens.
Background:
Ventriculoperitoneal (VP) shunt placement, the mainstay of treatment for hydrocephalus, can place a substantial burden on patients and health care systems because of high complication and revision rates. We aimed to identify factors associated with 30-day VP shunt failure in children undergoing either initial placement or revision.
Methods:
VP shunt placements performed on patients in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric were identified.
Results:
VP shunts were placed in 3,984 patients either as an initial placement (n = 1,093) or as a revision (n = 2,891). Compared to the initial-placement group, the revision group was significantly more likely to experience shunt failure (14 vs. 8%, p < 0.0001). In the initial-placement group, congenital hydrocephalus was independently associated with shunt failure (OR 1.83; 95% CI 1.01-3.31, p = 0.047). In the revision group, cardiac risk factors (OR 1.38; 95% CI 1.00-1.90, p = 0.047), a chronic history of seizures (OR 1.33; 95% CI 1.04-1.71, p = 0.022), and a history of neuromuscular disease (OR 0.61; 95% CI 0.41-0.90, p = 0.014) were independently associated with shunt failure.
Conclusions:
Identifying the factors associated with VP shunt failure may allow the development of interventions to decrease failures. Further refinement of the collected variables in the NSQIP Pediatric specific to neurosurgical procedures is necessary to identify modifiable risk factors.
