Introduction: Complications from ventriculoperitoneal shunting are well-known and costly. Revision rates at certain time periods (ex. 30, 60 and 180-days) have been proposed as quality metrics. The purpose of this study was to perform a detailed analysis of shunt failure etiology in an effort to produce a more appropriate quality metric.
Methods: Le Bonhuer Children’s Hospital records were reviewed to identify all patients admitted for shunt related procedures (01/2010-06/2014). Shunt malfunctions within 90-days of index procedure were reviewed thoroughly to identify the root cause of shunt malfunction. Extracted data for each index and revision procedure included demographic, clinical and operative.
Results: We identified 188 failures within 90-days of the index shunt operation, the majority of them occurring within 30 days (70.2%). The most common types of failure included surgical site infection (14.9%), proximal catheter (43.6%), valve malfunction(12.2%), distal catheter (15.4%), and some combination (6.3%). Potentially preventable shunt failures, which included malpositioned proximal and distal catheters and infection, comprised 29.8% of the 90-day failures.
Conclusions: An overall shunt revision rate at any time period is not an appropriate quality metric. However, we have identified a new metric – the preventable shunt revision rate (PSRR) – at 90 days as a metric that is meaningful, measureable and modifiable. It is the one that all institutions should track and institute processes to minimize.
Patient Care: The Preventable Shunt Revision Rate can be used to track early shunt malfunctions and institute a strategy to lower it, which will translate into lower overall shunt malfunction rates.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of preventing shunt malfunction, 2) Discuss, in small groups, the key attributes of a quality metric, 3) Identify an effective strategy to prevent early shunt malfunction.