Postconception age at surgery as a predictor of ventriculoperitoneal shunt failure
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Published on: November 28, 2018
Hannah G Black1, E Alice Woolard1,2, Caren M Stuebe3
11School of Medicine.
Insights
Infants undergoing ventriculoperitoneal (VP) shunt placement for hydrocephalus have higher failure rates if their postconception age at surgery (PCAS) is less than 40 weeks. This developmental milestone is a key predictor of VP shunt success.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Surgical Outcomes
Background:
- Ventriculoperitoneal (VP) shunts are the primary treatment for pediatric hydrocephalus.
- VP shunts exhibit high failure rates, particularly in premature infants.
- Current risk factors like prematurity do not fully capture developmental maturity at surgery.
Purpose of the Study:
- To evaluate postconception age at surgery (PCAS) as a predictor of VP shunt failure.
- To investigate the significance of a 40-week PCAS threshold for shunt outcomes.
- To compare PCAS with prematurity status in predicting shunt failure.
Main Methods:
- Retrospective analysis of first-time VP shunt placements (2010-2021) at a single institution.
- Parallel analysis using the National Surgical Quality Improvement Program (NSQIP) pediatric hydrocephalus dataset.
- Comparison of shunt failure rates based on PCAS < 40 weeks versus PCAS ≥ 40 weeks.
Main Results:
- Infants with PCAS < 40 weeks had 2.4 times higher odds of shunt failure in the institutional cohort.
- In the NSQIP dataset, infants with PCAS < 40 weeks had 1.45 times higher odds of shunt failure.
- A PCAS < 40 weeks was a significant predictor of VP shunt failure.
Conclusions:
- The 40-week PCAS threshold is a significant predictor of VP shunt failure in pediatric hydrocephalus.
- Assessing developmental stage via PCAS is crucial for risk stratification, beyond prematurity alone.
- This highlights the importance of considering neurodevelopmental maturity in surgical planning.
Objective:
The gold standard of pediatric hydrocephalus management is the ventriculoperitoneal (VP) shunt. However, VP shunts have high failure rates, and both young age and prematurity have been identified as potential risk factors for shunt failure, although neither variable describes total development at the time of surgery. This study aimed to further characterize age and shunt failure through the use of postconception age at surgery (PCAS) as well as investigate the 40-week PCAS threshold initially described in 1999.
Methods:
A retrospective analysis was conducted on all first-time shunt placements at the authors' institution from 2010 to 2021. The National Surgical Quality Improvement Program (NSQIP) pediatric hydrocephalus dataset was used as a parallel analysis to ensure representativeness of the national pediatric hydrocephalus population.
Results:
In the institutional cohort, infants with a PCAS < 40 weeks exhibited 2.4 times greater odds of shunt failure than those with a PCAS ≥ 40 weeks. In the NSQIP dataset, infants with a PCAS < 40 weeks had 1.45 times greater odds of shunt failure compared with those with a PCAS ≥ 40 weeks.
Conclusions:
The 40-week PCAS threshold appears to be a significant predictor of shunt failure in pediatric patients with hydrocephalus. This finding underscores the importance of considering the developmental stage at the time of surgery, rather than just prematurity status, when assessing shunt failure risk.
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