• Kanwaljeet Garg, Satish Kumar Verma, SinghPankaj KumarPKDepartment of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India., Manmohan Singh, P Sarat Chandra, and Shashank S Kale.
• Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. Electronic address: kanwaljeet84@gmail.com.
• World Neurosurg. 2022 Feb 1; 158: 268-278.e4.

BackgroundExternal ventricular drain (EVD)-associated cerebrospinal fluid infection (EACI) remains a major complication associated with EVD. Length of EVD tunnel, an overlooked but modifiable factor, can be associated with increased risk of EACI. The aim of this study is to find the tunnel length associated with least chances of EACI by performing a network meta-analysis.MethodsA comprehensive search of different databases was performed to retrieve studies that studied the rates of EACI with different EVD tunnel lengths and a Bayesian network meta-analysis was performed.ResultsSix studies met the inclusion criteria and were included in the network meta-analysis. With 0 cm tunnel length as reference, the odds ratio (OR) for developing EACI was minimum for tunnel length 5-10 cm (OR, 0.027). It was followed by tunnel length of 5 cm (OR, 0.060) and 10 cm (OR, 0.075). The surface under the cumulative ranking curve plot showed that the probability of the tunnel length 5-10 cm (ranked first), 5 cm (ranked second), and 10 cm (ranked third) for being the best EVD tunnel length was found to be 86%, 64%, and 61%, respectively.ConclusionsThe length for which an EVD is tunneled may have an impact on the rate of EACI. Our network meta-analyses showed that the tunnel length of 5-10 cm was associated with the lowest rates of EACI, with 86% probability of being the best EVD tunnel length. The probability of a patient with 5-10 cm EVD length developing EACI was 2.7% compared with zero tunnel length.Copyright © 2021 Elsevier Inc. All rights reserved.

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