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Negative predictors of shunt surgery outcome in normal pressure hydrocephalus
Henrik Bådagård1, Madelene Braun1, Dag Nilsson1
1Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
Insights
Older age and cerebrovascular disease negatively impact outcomes for idiopathic normal pressure hydrocephalus (iNPH) patients undergoing shunt surgery. These factors predict less favorable results following the procedure.
Area of Science:
- Neurology
- Neurosurgery
- Geriatrics
Background:
- Idiopathic normal pressure hydrocephalus (iNPH) prevalence and vascular comorbidities increase with age.
- The influence of advanced age and vascular disease on shunt surgery outcomes in iNPH patients remains unclear.
Purpose of the Study:
- To determine if advanced age and vascular comorbidities negatively predict shunt surgery outcomes in iNPH patients.
- Investigate the impact of high age and vascular comorbidity on shunt surgery outcomes in iNPH.
Main Methods:
- A cohort of 332 iNPH patients treated with shunts from 2011-2015 were analyzed.
- The Hellström iNPH scale assessed outcomes 12 months post-surgery.
- Multivariable analysis identified predictors of shunt surgery outcome.
Main Results:
- Increasing age was a significant negative predictor of shunt surgery outcome (B = -0.63, P < .001).
- A history of ischemic stroke also negatively predicted outcome (B = -10.06, P = .0038).
- These findings persisted after controlling for multiple confounding factors.
Conclusions:
- Advanced age is associated with less favorable outcomes after shunt surgery in iNPH patients.
- Established cerebrovascular disease, specifically ischemic stroke, predicts poorer outcomes post-shunt surgery in iNPH.
- These factors should be considered when evaluating iNPH patients for shunt intervention.
Objectives:
The prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH. The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH.
Methods:
All 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included. Hellström iNPH scale, without the neuropsychological tests, was calculated preoperatively and at follow-up 12 months after shunt surgery. Outcome was defined as the difference between the post-operative and preoperative iNPH scale scores. A multivariable model was used to investigate the predictive effects of age and vascular comorbidity on shunt surgery outcome.
Results:
In a multivariable analysis of covariance (ANCOVA) with post-operative outcome as the dependent variable, increasing age (years, B = -0.63, P < .001) and history of ischaemic stroke (B = -10.06, P = .0038) were negative predictors of shunt surgery outcome after controlling for waiting time for surgery, symptom severity at preoperative control, presence of diabetes mellitus, hypertension, hyperlipidaemia, history of myocardial infarction, duration of symptoms and shunt complications.
Conclusions:
High age and established cerebrovascular disease are associated with less favourable outcome after shunt surgery in patients with iNPH.
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