Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement and Reduction in Operative Time and Total Hospital Charges

• Published in: World neurosurgery 2020-03, Vol.135, p.e623-e628
• Main Authors: Catapano, Joshua S., Mezher, Andrew W., Wang, Derrick J., Whiting, Alexander C., Mooney, Michael A., Bohl, Michael A., Sheehy, John P., DiDomenico, Joseph D., Sarris, Christina E., Smith, Kris A., Lawton, Michael T., Zabramski, Joseph M.
• Format: Article
• Language: English
• Subjects: Equipment Failure; Female; Hospital Charges; Humans; Hydrocephalus, Normal Pressure - economics; Hydrocephalus, Normal Pressure - surgery; Laparoscopic-assisted ventriculoperitoneal shunt placement; Laparoscopy - economics; Laparoscopy - methods; Male; Middle Aged; Normal pressure hydrocephalus; Operative Time; Reoperation - statistics & numerical data; Retrospective Studies; Ventriculoperitoneal Shunt - economics; Ventriculoperitoneal Shunt - methods
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.12.086

In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter will typically be performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. The present study examined whether LA placement of a VPS (LAVPS) is associated with a reduced operative time, lower hospital costs, and fewer distal revisions. A retrospective review was performed of the data from all patients who had received a new VPS at our institution from 2013 to 2016. Age, sex, diagnosis, previous abdominal surgery, operative time, anesthesia grade, incidence of 30-day shunt failure, and total hospital charges were analyzed. A total of 680 patients had undergone first-time VPS placement, including 199 with LAVPS and 481 with non–LAVPS placement (non-LAVPS). The mean age of the LAVPS patients was significantly older than that of the non-LAVPS patients (64.1 vs. 59.3 years; P = 0.002). The mean operative time was shorter in the LAVPS group than in the non-LAVPS group (55 vs. 75 minutes; P < 0.001). Distal shunt revision within 30 days occurred more often for the non-LAVPS patients (6 of 481 [1.2%]) than for the LAVPS patients (0 of 199 [0%]). A subset analysis of patients with normal-pressure hydrocephalus found decreased total hospital charges in the LAVPS group ($67,124 vs. $80,890; P = 0.009). Compared with non-LAVPS, LAVPS was associated with significantly shorter operative times and fewer distal shunt revisions within 30 days. The findings from a subset analysis supported a decrease in total hospital charges. Additional studies are needed; however, these data suggest that LAVPS is a safer, less-expensive alternative to non-LAVPS.