Risk Factors for 30-Day Postoperative Infection in Pediatric Ventricular Shunts for Hydrocephalus

Ventricular shunt infections lead to significant morbidity and mortality. This study aimed to identify risk factors for 30-day postoperative infection outcomes of ventricular shunt surgery for pediatric hydrocephalus.

This retrospective cohort study used the National Surgical Quality Improvement Program Pediatric database for the years 2016-2021. Patients were included in this study if they were <18 years old and underwent ventricular shunt surgery. The primary outcome was 30-day postoperative shunt infection. A multivariable logistic regression analysis was performed using 14 prognostic variables to determine factors associated with infection risk.

The study included 10,878 patients with a mean (SD) age of 3.1 (4.83) years; 44.2% were girls. The overall 30-day postoperative shunt infection rate was 3.7%. Infection risk increased in patients with nutritional support, longer operating room time, and congenital hydrocephalus. Conversely, infection risk decreased with increasing patient age, delivery of intraoperative intraventricular antibiotics, and first-time shunt placement. Variables that did not significantly affect the risk of 30-day postoperative shunt infection included sex, body mass index, ostomy, tracheostomy, neuromuscular disease, structural pulmonary/airway abnormality, steroid use within 30 days, antibiotic-impregnated shunt use, and endoscopy for catheter placement.

Various modifiable and nonmodifiable factors are associated with postoperative shunt infections. Recognizing and modifying risk factors can reduce pediatric shunt infections, thereby preventing revisions and improving therapeutic outcomes and quality of life.