Survival outcomes and risk factors for ventriculo-peritoneal shunt failure in pediatric hydrocephalus: a multi-center...

This study aims to assess the survival outcomes of ventriculo-peritoneal shunt (VPS) and identify risk factors for shunt failure when using the standardized protocol in Vietnamese children.

This was a multi-center retrospective cohort study at four pediatric centers in Vietnam. All patients less than 16 years old who underwent initial VPS placement between 2021 and 2024 were included. The Kaplan-Meier method was employed for survival analysis. Risk factors were identified using Cox regression models.

A total of 334 individuals were enrolled with a median follow-up (FU) of 21 months. Brain tumors (59.6%), post-meningitis (14.7%), and congenital abnormalities (14.3%) were the most common etiologies of hydrocephalus. Shunt infection rate was 14.1%. Low rate of full compliance with protocol (39.5%) increased shunt infection (p = 0.01). The 1-, 2-, and 3-year overall survival (OS) of VPS was 69%, 64%, and 61%, respectively, with an estimated mean survival time (ST) of 26 months. Post-meningitis hydrocephalus, non-compliance with shunt protocol, and improper technique were independent risk factors for shunt failure with adjusted hazard ratios (95% confidence interval) (aHR [CI]) of 1.82 (1.09-3.03), 1.69 (1.08-2.64), and 5.57 (2.90-10.69), respectively.

The shunt survival outcomes in Vietnamese children remain consistent with those in other populations in similar settings. Post-meningitis hydrocephalus, non-compliance, and improper technique are independently associated with reduced shunt survival. Recommendations include standardizing surgical techniques and ensuring full compliance with shunt protocol to prevent infection and improve shunt outcomes. This study also underscores the feasibility and efficiency of implementing the standardized shunt protocol in resource-limited countries.