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The Association Between Ventriculo-Peritoneal Shunt and Acute Appendicitis in Patients with Traumatic Brain Injury: A
Sher-Wei Lim1, Kam-Hou Ao2, Chung-Han Ho3
1Department of Neurosurgery, Chi-Mei Hospital, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
Insights
Ventriculoperitoneal (VP) shunts do not increase appendicitis risk in traumatic brain injury (TBI) patients. However, central nervous system (CNS) infections in TBI patients with VP shunts elevate appendicitis risk, highlighting infection prevention importance.
Area of Science:
- Neuroscience
- Surgical Innovation
- Infectious Disease Epidemiology
Background:
- Traumatic brain injury (TBI) often necessitates ventriculoperitoneal (VP) shunts for cerebrospinal fluid management.
- The potential association between VP shunts and secondary conditions like acute appendicitis in TBI patients remains unclear.
- Understanding these associations is crucial for comprehensive patient care and risk stratification.
Purpose of the Study:
- To investigate the relationship between preexisting VP shunts and the incidence of acute appendicitis in patients with TBI.
- To identify potential risk factors for acute appendicitis in this specific patient cohort.
Main Methods:
- A propensity score-matched longitudinal cohort study was performed.
- Data from 4781 TBI patients with VP shunts and 9562 TBI patients without VP shunts were analyzed.
- The study utilized Taiwan's National Health Insurance Research Database from January 1993 to December 2013.
Main Results:
- No significant difference in the cumulative probability of acute appendicitis was observed between TBI patients with and without VP shunts (P = 0.6244).
- Central nervous system (CNS) infection emerged as an independent predictor of acute appendicitis (adjusted hazard ratio = 2.98).
- TBI patients with both a VP shunt and a CNS infection exhibited a significantly higher risk of acute appendicitis (hazard ratio = 4.25; 95% CI: 1.84–9.81) compared to those without either condition.
Conclusions:
- VP shunts are not identified as a risk factor for appendicitis development in TBI patients.
- The presence of both a VP shunt and a CNS infection in TBI patients is associated with an increased risk of acute appendicitis.
- Preventing CNS infections is paramount for mitigating the risk of appendicitis in TBI patients with VP shunts.
Objective:
The association between preexisting ventriculoperitoneal (VP) shunt and the risk of new-onset acute appendicitis in patients with traumatic brain injury (TBI) is not well established. The aim of the present study was to determine the relationships between VP shunt and acute appendicitis in patients with TBI.
Methods:
A longitudinal cohort study matched by a propensity score in patients with TBI with (4781 patients) or without (9562 patients) VP shunt was conducted using the National Health Insurance Research Database in Taiwan between January 1993 and December 2013.
Results:
The main outcome studied was diagnosis of acute appendicitis. The cumulative probability of acute appendicitis was not different between these 2 groups (P = 0.6244). A Cox model showed central nervous system (CNS) infection to be an independent predictor of acute appendicitis with an adjusted hazard ratio of 2.98. Patients with TBI with both a VP shunt and a CNS infection had a greater risk of developing new-onset acute appendicitis (hazard ratio 4.25; 95% confidence interval 1.84-9.81) compared patients with TBI without a VP shunt or CNS infection.
Conclusions:
We concluded that VP shunt is not a risk factor in the development of appendicitis in patients with TBI. Patients with TBI with a shunt and a CNS infection may have a greater risk of developing acute appendicitis. Therefore, care in avoiding CNS infection is a key for the prevention acute appendicitis in this patient population.