Introduction: Ventriculoperitoneal (VP) shunting is one of the primary approaches to treat patients with hydrocephalus. However, 44.3-81% of patients require at least one surgical revision due to shunt complications. A recent study suggests a lower rate of 15% of patients who required future surgeries. Previous studies have found that demographic and etiological factors correlated with shunt revision rates. The goal of this study was to analyze preoperative characteristics and to determine whether hydrocephalus etiology, co-morbidities and baseline symptoms are associated with shunt revisions.
Methods: A retrospective review of patients treated with VP shunts by the senior author between 1993 and 2013 was conducted. Patients with missing data critical to the study were excluded. Demographics, etiology of hydrocephalus, type of hydrocephalus, co-morbidities, and baseline symptoms were compared between patients with and without shunt revision. The total number of revisions required and time to first revision were examined for each baseline characteristic.
Results: A total of 639 patients who received VP shunts were included. Median age at treatment was 71 years-old, with 329 (51.5%) males. Overall, 190 (29.7%) patients required shunt revision with a median of 1 revision per patient. The median time to revision was 8.5 months. Patients that had hydrocephalus caused by an infection received a greater number of revisions than did patients who had idiopathic hydrocephalus (p = 0.005). A higher Kiefer Comorbidity Index was not associated with having a higher total number of revisions (p = 0.099). Nausea at baseline was correlated with a higher number of revisions (OR 2.28 95% CI 1.03 – 5.05; p = 0.0439).
Conclusions: Preoperative characteristics including hydrocephalus etiology and presenting symptoms, but not co-morbidities, are associated with surgical revision. Our results suggest that the etiology of the hydrocephalus and presenting symptoms must be considered when counseling patients on outcomes of VP shunting.
Patient Care: By identifying patients that are at high risk for revision, this will help the surgeon to be more careful when deciding whether to operate on these patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the method of treatment for hydrocephalus 2) Discuss the factors that increase the risk for shunt failure 3) Discuss the risks associated with shunt placement, including the risk for revision