• World Neurosurg · Apr 2019

    Factors Associated with Ventriculoperitoneal Shunt Failures in the First 30 Postoperative Days in Pediatric Patients.

    • Eduardo Orrego-González, Alejandro Enriquez-Marulanda, Krishnan Ravindran, Daniel Celin-Varcalcel, Laura Parrado-Sánchez, and Javier Lobato-Polo.
    • Fundacion Valle del Lili, Cali, Colombia, USA; Universidad ICESI, Cali, Colombia, USA.
    • World Neurosurg. 2019 Apr 1; 124: e517e526e517-e526.

    ObjectivePlacing of a ventriculoperitoneal shunt (VPS) is one of the most common procedures performed by neurosurgeons. Surgical revision of VPS is a significant cause of patient morbidity and mortality. This study was aimed to provide an analysis of factors related to VPS failures in the first 30 postoperative days in a pediatric cohort.MethodsThis was a retrospective cohort study of 83 pediatric patients (<18 years old), shunted for the first time at a referral care center, between January 2012 and December 2016. Univariate analysis was used to detect potential predictors of VPS failures within the first 30 postoperative days and in the first 6 months of follow-up. Kaplan-Meier survival curves were used to examine the occurrence of VPS failures over time.ResultsDuring the first 30 postoperative days, VPS failures occurred in 21 patients (25.3%). Intraventricular hemorrhage (IVH) (odds ratio [OR], 4.41; 95% confidence interval [CI], 1.44-13.48), cerebrospinal fluid (CSF) alterations (OR, 5.11; 95% CI, 1.37-19.1), and previous external ventricular drain (EVD) (OR, 7.05; 95% CI, 1.18-41.8) were significantly associated with shunt failure during the first postoperative month. Kaplan-Meier survival analysis showed decreased shunt survival for patients with IVH, both during the first 30 days after surgery (P = 0.005, log-rank), and during the 6 months after surgery (P = 0.005, log-rank).ConclusionsIn this study, we found that in pediatric patients, IVH was associated with VPS failure within the first 30 postoperative days and decreased shunt survival over time. Further larger prospective randomized studies are needed to better understand these results.Copyright © 2019 Elsevier Inc. All rights reserved.

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