Reimagining durability of hydrocephalus treatment using conditional survival
Aaron M Yengo-Kahn1,2, John C Wellons3, Hailey Jensen4
11Department of Neurosurgery, University of Utah, Salt Lake City, Utah.
Insights
Patients treated for hydrocephalus have a high chance of remaining revision-free long-term if they avoid surgery in the first year. Conditional survival analysis offers valuable insights for patient counseling.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Statistics
Background:
- Hydrocephalus treatment outcomes require accurate prognostication.
- Conditional survival analysis provides time-dependent survival probabilities.
- Improving patient and family counseling is crucial after hydrocephalus treatment.
Purpose of the Study:
- To analyze conditional survival rates after hydrocephalus treatment.
- To enhance counseling for patients and families regarding long-term outcomes.
- To evaluate survival probabilities for ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV).
Main Methods:
- Analysis of data from the Hydrocephalus Clinical Research Network (HCRN) registry.
- Inclusion of children with hydrocephalus undergoing first-time VPS or ETV with at least 3 years of follow-up.
- Calculation of failure-free survival probabilities at 3, 5, and 10 years as a function of time since surgery.
Main Results:
- Overall 3-, 5-, and 10-year failure-free survival rates were 59%, 58%, 57% for ETV and 62%, 58%, 54% for VPS.
- Post-1-year conditional survival rates significantly improved: 85%, 79%, 66% for VPS and 93%, 91%, 86% for ETV.
- Conditional survival varied by patient age and hydrocephalus etiology.
Conclusions:
- Patients avoiding revision surgery in the first year have excellent long-term revision-free chances.
- Conditional survival plots are intuitive tools for counseling patients with surgically treated hydrocephalus.
- This analysis supports informed decision-making for hydrocephalus management.
Objective:
Conditional survival incorporates the effect of time passed since an event to current data in an easy-to-understand, relevant format. Data from the Hydrocephalus Clinical Research Network (HCRN) registry were analyzed with conditional survival to improve patient and family counseling after hydrocephalus treatment.
Methods:
Children with hydrocephalus who underwent first-time treatment by a single proximal catheter ventriculoperitoneal shunt (VPS) or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization with at least 3 years of follow-up in the prospective HCRN registry (14 sites, April 24, 2008-December 31, 2020) were included. Those with nonperitoneal or multiple proximal catheters were excluded. The probability of failure-free survival at 3, 5, and 10 years was calculated as a function of time since surgery.
Results:
Overall, 5782 patients were included (1609 with ETV, 4173 with VPS placement). The median time to censoring was 5.3 years. The overall respective 3-, 5-, and 10-year failure-free survival rates were 59%, 58%, and 57%, respectively, for ETV and 62%, 58%, and 54%, respectively, for VPS. If VPS failure had not occurred by 1 year postoperatively, the 3-, 5-, and 10-year failure-free survival rates were 85%, 79%, and 66%, respectively. If ETV failure had not occurred by 1 year, the 3-, 5-, and 10-year failure-free survival rates were 93%, 91%, and 86%, respectively. Conditional survival also varied by age and etiology.
Conclusions:
Patients who do not require revision surgery in the 1st year have an excellent chance of being revision free for an extended period. Conditional survival plots provided are intuitive and can be used in the counseling of North American patients with surgically treated hydrocephalus.
