The Rate of Complications after Ventriculoperitoneal Shunt Surgery

• Published in: World neurosurgery 2017-02, Vol.98, p.654-658
• Main Authors: Merkler, Alexander E., MD, Ch’ang, Judy, MD, Parker, Whitney E., MD, PhD, Murthy, Santosh B., MD, MPH, Kamel, Hooman, MD
• Format: Article
• Language: English
• Subjects: Brain abscess; Brain Abscess - epidemiology; Brain Abscess - surgery; Central Nervous System Bacterial Infections - epidemiology; Central Nervous System Bacterial Infections - surgery; Central nervous system infections; Epidemiology; Female; Florida - epidemiology; Humans; Hydrocephalus; Hydrocephalus - epidemiology; Hydrocephalus - surgery; Male; Middle Aged; Neurosurgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Ventriculoperitoneal Shunt - adverse effects; Ventriculoperitoneal Shunt - statistics & numerical data; Ventriculoperitoneal shunts
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.10.136

Abstract Background Although ventriculoperitoneal shunt (VPS) surgery is the most frequent surgical treatment for patients with hydrocephalus, modern rates of complications in adults are uncertain. Methods We performed a retrospective cohort study of adult patients hospitalized at the time of their first recorded procedure code for VPS surgery between 2005 and 2012 at nonfederal acute care hospitals in California, Florida, and New York. We excluded patients who during the index hospitalization for VPS surgery had concomitant codes for VPS revision, CNS infection, or died during the index hospitalization. Patients were followed for the primary outcome of a VPS complication, defined as the composite of CNS infection or VPS revision. Survival statistics were used to calculate the cumulative rate and incidence rate of VPS complications. Results 17,035 patients underwent VPS surgery. During a mean follow-up of 3.9 (±1.8) years, at least one VPS complication occurred in 23.8% (95% CI, 22.9-24.7%) of patients. The cumulative rate of CNS infection was 6.1% (95% CI, 5.7-6.5%) and of VPS revision 22.0% (95% CI, 21.1-22.9%). The majority of complications occurred within the first year of hospitalization for VPS surgery. Complication rates were 21.3 (95% CI, 20.6-22.1) complications per 100 patients per year in the first year after VPS surgery, 5.7 (95% CI, 5.3-6.1) in the second year after VPS surgery, and 2.5 (95% CI, 2.1-3.0) in the fifth year after VPS surgery. Conclusions Complications are not infrequent following VPS surgery; however, the majority of complications appear to be clustered in the first year following VPS insertion.