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Racial and ethnic disparities in early unplanned cerebrospinal fluid shunt revision in infants
Ashley Smith1, Sandra Tay1, Albert M Isaacs2
1Departments of1Anesthesiology and Pain Medicine and.
Insights
Black infants face a higher risk of early cerebrospinal fluid (CSF) shunt revision compared to White infants. This highlights the need for equitable preventative strategies in pediatric neurosurgery.
Area of Science:
- Pediatric Neurosurgery
- Health Disparities
- Surgical Outcomes
Background:
- Cerebrospinal fluid (CSF) shunt placement is a common pediatric neurosurgical procedure with an 8% infant failure rate.
- Racial and ethnic disparities in pediatric surgical outcomes are known, but their impact on CSF shunt outcomes is understudied.
Purpose of the Study:
- To evaluate the association between race and ethnicity and early unplanned CSF shunt revision in infants.
- To test the hypothesis that Black and Hispanic infants have a higher risk of revision compared to White infants.
Main Methods:
- Retrospective cohort study using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2016-2021).
- Included infants (<1 year) undergoing first-time permanent CSF shunt placement.
- Analyzed early unplanned shunt revision (within 30 days) using multivariable log-binomial regression.
Main Results:
- 8.4% of 4478 infants required early unplanned shunt revision.
- Black infants showed a 35% increased risk of revision compared to White infants (aRR 1.35, p=0.008).
- Hispanic infants had a similar risk to White infants (aRR 1.03, p=0.820). The disparity persisted in full-term infants.
Conclusions:
- Black infants have a significantly higher risk of early unplanned CSF shunt revision.
- Emphasizes the need for equitable preventative strategies to mitigate CSF shunt complications in all pediatric populations.
Objective:
CSF shunt placement is a common pediatric neurosurgical procedure. Early failure of newly placed CSF shunts is a considerable risk, occurring in 8% of infants. Significant racial and ethnic disparities in pediatric surgical outcomes have been demonstrated previously; however, the association of race and ethnicity with shunt outcomes is understudied. The objective of the authors' study was to evaluate the association of race and ethnicity with early unplanned CSF shunt revision. The authors hypothesized that non-Hispanic Black and Hispanic infants would have higher risk of early unplanned CSF shunt revision compared to non-Hispanic White peers.
Methods:
This retrospective cohort study analyzed data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2016 to 2021. The authors included children < 1 year of age who underwent first-time permanent shunt placement. Early unplanned shunt revision was defined as any revision or reoperation within 30 days postoperatively. The authors estimated adjusted risk ratios (aRRs) for race and ethnicity using multivariable log-binomial regression. In this study, p values < 0.05 were considered significant.
Results:
During the study period, 4478 children < 1 year of age underwent first-time CSF shunt placement. Of those, 375 (8.4%) required early unplanned shunt revision. Compared with White infants, Black infants had a 35% increased risk of revision (aRR 1.35, 95% confidence interval [CI] 1.08-1.69, p = 0.008). Hispanic infants had a similar risk to White infants (aRR 1.03, 95% CI 0.79-1.34, p = 0.820). When results were stratified on the basis of gestational age, the racial disparity remained significant among full-term infants (aRR for Black vs White, 1.47; 95% CI 1.07-2.01, p = 0.017) but not among preterm infants (aRR 1.31, 95% CI 0.97-1.79, p = 0.082).
Conclusions:
Black infants had higher risk of early unplanned CSF shunt revision compared to White infants. These findings underscore the importance of equitable application of preventative strategies to reduce CSF shunt complications across all pediatric populations.
