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Area of Science:

  • Neurosurgery
  • Gastroenterology
  • Medical device implantation

Background:

  • Neurological injuries often necessitate ventriculoperitoneal shunts (VPS) and gastrostomy for nutritional support.
  • The optimal timing for these procedures is debated due to concerns about shunt infection and displacement.

Purpose of the Study:

  • To determine the ideal sequence for placing ventriculoperitoneal shunts and gastrostomy tubes in adult patients.
  • To evaluate the impact of procedural sequencing on revision and infection rates.

Main Methods:

  • Analysis of an all-payer database for adult patients undergoing both VPS and gastrostomy within 15 days (January 2010 - October 2021).
  • Patients were grouped by the order of procedures: gastrostomy before VPS, same-day, or gastrostomy after VPS.
  • Primary outcomes (revision and infection rates) were assessed up to 30 months post-shunting.

Main Results:

  • Concurrent VPS and gastrostomy placement showed significantly lower revision rates compared to gastrostomy after VPS (OR 0.61).
  • Gastrostomy before VPS also resulted in lower revision rates (OR 0.61) and notably lower infection rates (OR 0.46) compared to gastrostomy after VPS.
  • No significant differences were observed in mechanical complication or shunt displacement rates between groups.

Conclusions:

  • Performing ventriculoperitoneal shunt and gastrostomy procedures concurrently or placing the gastrostomy before the shunt may reduce revision rates.
  • Placing the gastrostomy before the ventriculoperitoneal shunt offers an additional benefit of decreased infection rates.