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Readmissions after ventricular shunting in pediatric patients with hydrocephalus: a Nationwide Readmissions Database
Daniel A Donoho1,2, Ian A Buchanan1,2, Shivani D Rangwala1,2
11Keck School of Medicine, University of Southern California, Los Angeles.
Insights
Shunt failure and hospital readmission are common in pediatric hydrocephalus patients after ventricular shunting. Focusing on care coordination for complex neurological conditions and reducing healthcare disparities is crucial for improving outcomes.
Area of Science:
- Pediatric Neurosurgery
- Health Services Research
Background:
- Ventricular shunting is a standard treatment for pediatric hydrocephalus.
- Longitudinal data on pediatric ventricular shunting outcomes in the U.S. are limited.
Purpose of the Study:
- To assess shunt failure and hospital readmission rates in pediatric patients undergoing new ventricular shunt placement.
- To identify patient- and hospital-level factors associated with shunt failure and readmission.
Main Methods:
- Analysis of a nationwide population-based dataset (Nationwide Readmissions Database) from 2010-2014.
- Inclusion of pediatric patients with hydrocephalus receiving new ventricular shunts.
- Evaluation of revision rates within 6 months and readmission rates at 30 and 90 days, alongside associated factors.
Main Results:
- Twenty percent of 3520 pediatric patients required shunt revision within 6 months.
- Readmission rates were 18% at 30 days and 31% at 90 days.
- Higher intraventricular hemorrhage grade correlated with shunt malfunction; private insurance and large hospital treatment were linked to lower readmission.
Conclusions:
- Shunt failure and readmission are frequent in pediatric hydrocephalus patients.
- Patient and hospital factors influence outcomes, but system-wide care fragmentation was not evident.
- Future efforts should prioritize care coordination for complex cases and address healthcare disparities to reduce readmissions.
Objective:
Cerebrospinal fluid diversion via ventricular shunting is a common surgical treatment for hydrocephalus in the pediatric population. No longitudinal follow-up data for a multistate population-based cohort of pediatric patients undergoing ventricular shunting in the United States have been published. In the current review of a nationwide population-based data set, the authors aimed to assess rates of shunt failure and hospital readmission in pediatric patients undergoing new ventricular shunt placement. They also review patient- and hospital-level factors associated with shunt failure and readmission.
Methods:
Included in this study was a population-based sample of pediatric patients with hydrocephalus who, in 2010-2014, had undergone new ventricular shunt placement and had sufficient follow-up, as recorded in the Nationwide Readmissions Database. The authors analyzed the rate of revision within 6 months, readmission rates at 30 and 90 days, and potential factors associated with shunt failure including patient- and hospital-level variables and type of hydrocephalus.
Results:
A total of 3520 pediatric patients had undergone initial ventriculoperitoneal shunt placement for hydrocephalus at an index admission. Twenty percent of these patients underwent shunt revision within 6 months. The median time to revision was 44.5 days. Eighteen percent of the patients were readmitted within 30 days and 31% were readmitted within 90 days. Different-hospital readmissions were rare, occurring in ≤ 6% of readmissions. Increased hospital volume was not protective against readmission or shunt revision. Patients with grade 3 or 4 intraventricular hemorrhage were more likely to have shunt malfunctions. Patients who had private insurance and who were treated at a large hospital were less likely to be readmitted.
Conclusions:
In a nationwide, population-based database with longitudinal follow-up, shunt failure and readmission were common. Although patient and hospital factors were associated with readmission and shunt failure, system-wide phenomena such as insufficient centralization of care and fragmentation of care were not observed. Efforts to reduce readmissions in pediatric patients undergoing ventricular shunt procedures should focus on coordinating care in patients with complex neurological diseases and on reducing healthcare disparities associated with readmission.
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