• Alexandra Backlund, Helena Kristiansson, Alexander Fletcher-Sandersjöö, and Lisa Arvidsson.
• Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
• World Neurosurg. 2025 Jan 29: 123737123737.

Background And ObjectivesHydrocephalus is a common neurosurgical condition treated primarily through ventriculoperitoneal (VP) shunt placement. This study aims to investigate the relationship between the timing of VP shunt surgery (on-call vs regular hours) and shunt failure rates.MethodsIn this single-center, population-based observational cohort study, all adult patients who underwent VP shunt surgery were included. The main outcome was reoperation due to shunt failure within 12 months of the index surgery, comparing rates between procedures performed during regular hours and on-call periods. Adjustments for confounders were made using multivariable logistic regression.ResultsOut of 810 cases included, 25% underwent surgery during on-call hours. Shunt failure occurred in 10% of cases, most often due to infection. Patients operated on during on-call hours had a significantly higher rate of shunt failure compared to those operated on during regular hours (17% vs. 7.9%, p < 0.001). However, after adjusting for confounders in a multivariable logistic regression, this relationship was no longer statistically significant (OR 1.60, p = 0.073).ConclusionThe rate of shunt failure was significantly greater in surgeries conducted during on- call hours as opposed to regular hours, but this was not statistically significant after adjusting for confounders. Therefore, the timing of VP shunt surgery may not be an independent risk factor for shunt failure. High-risk scenarios still deserve added caution, and further research is needed to identify factors influencing shunt outcomes and develop strategies to minimize failure rates.Copyright © 2025. Published by Elsevier Inc.

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