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Published on: February 11, 2017
Ventriculoperitoneal shunt failures at Red Cross War Memorial Children's Hospital
J S Lazarus1,2, E Ohonba3,4, Y J Li5
1Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa. jed.lazarus@gmail.com.
Insights
Ventriculoperitoneal shunt failure is common, especially in revision surgeries. Careful initial placement is crucial to minimize risks like blockage and disconnection.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Device Performance
Background:
- Ventriculoperitoneal (VP) shunts are vital for hydrocephalus treatment.
- High rates of VP shunt failure necessitate further investigation.
Purpose of the Study:
- Quantify VP shunt failure rates at Red Cross War Memorial Children's Hospital.
- Identify factors contributing to VP shunt failures in pediatric patients.
Main Methods:
- Retrospective review of 494 VP shunt operations (2015-2019).
- Analysis of patient demographics, hydrocephalus etiology, and shunt system variables.
- Univariate and multivariate models to assess failure relationships.
Main Results:
- Overall VP shunt failure rate was 31.2%.
- Revision shunts had higher failure rates (34.7%) than index shunts (27.3%).
- Common failures included blockage (13.6%) and infection (7.3%).
Conclusions:
- VP shunt failure is more prevalent in revision surgeries.
- Proactive measures during initial surgery are recommended to reduce failure.
- Further research on large head circumferences and socioeconomic factors is warranted.
Introduction:
Ventriculoperitoneal shunt (VP shunt) insertion is one of the mainstays of treatment of hydrocephalus and although very effective, a high rate of shunt failure persists globally. The purpose of the study was to quantify the ventriculoperitoneal shunt failure rate at Red Cross War Memorial Children's Hospital (RCWMCH) and assess potential factors contributing to shunt failures.
Methods:
A retrospective review of VP shunts done at RCWMCH between August 2015 through December 2019 was performed. Operative notes, discharge summaries and patient folders were reviewed to collect information about patient age, aetiology of hydrocephalus, index vs revision shunt, shunt system and other noticeable variables. Overall shunt failure was recorded. Univariate and multivariate models were used to determine causal relationship.
Results:
Four hundred and ninety-four VP shunt operations were performed on 340 patients with 48.8% being index shunts and 51.2% revision shunts. The average patient age was 3.4 months. The total VP shunt failure rate over the study period was 31.2%, with a 7.3% infection rate, 13.6% blockage and 3.6% disconnection rate. The most common aetiologies were post-infectious hydrocephalus 29.4%, myelomeningocele 19.7% and premature intraventricular haemorrhage 14.1%. Orbis-sigma II (OSVII), distal slit valves and antibiotic-impregnated catheters were used most frequently. Failure rates were highest in the revision group, 34.7% compared to 27.3% in index shunts. Sixty-five percent (65%) of the head circumferences measured were above the + 3 Z score (> 90th centile).
Conclusion:
VP shunt failure occurs most commonly in revision surgery, and care should be taken at the index operation to reduce failure risk. Surgeon level, duration of surgery, aetiology of hydrocephalus and shunt system used did not influence overall failure rates. A closer look at larger head circumferences, their effect on shunt systems and the socio-economic factors behind late presentations should be investigated further in the future.
