• Paul Klimo, Garrett T Venable, and Nicholas Rossi.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:230.

IntroductionComplications from ventriculoperitoneal shunting are well-known and costly. Revision rates at certain time periods (eg 30, 60, and 180 days) have been proposed as quality metrics. The purpose of this study was to perform a detailed analysis of shunt failure etiology in an effort to produce a more appropriate quality metric.MethodsLe Bonhuer Children's Hospital records were reviewed to identify all patients admitted for shunt-related procedures (January 2010-February 2014). Shunt malfunctions within 90 days of the index procedure were reviewed thoroughly to identify the root cause of shunt malfunction. Extracted data for each index and revision procedure included demographic, clinical and operative.ResultsWe identified 188 failures within 90 days of the index shunt operation, the majority of them occurring within 30 days (70.2%). The most common types of failure included surgical site infection (14.9%), proximal catheter (43.6%), valve malfunction (12.2%), distal catheter (15.4%), and some combination (6.3%). Potentially preventable shunt failures, which included malpositioned proximal and distal catheters and infection, comprised 29.8% of the 90-day failures.ConclusionAn overall shunt revision rate at any time period is not an appropriate quality metric. However, we have identified a new metric the preventable shunt revision rate (PSRR) at 90 days as a metric that is meaningful, measureable, and modifiable. It is the one that all institutions should track and institute processes to minimize.

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