Introduction: Many patients requiring ventricular shunting have comorbidities requiring a gastrotomy tube for nutrition, raising the question of whether the order of VPS and PEG placement has an impact on complication rate. We endeavored to assess whether the order and timing of ventricular shunting and PEG procedures had an effect on complication rate and shunt failure.
Methods: Patients who underwent ventricular shunting with a single surgeon and also had a PEG placed at the same institution were included. A retrospective chart review abstracted age, sex, etiology shunt requirement, shunt date, type of shunt, shunt complications, presence of general assistance for shunting procedure, PEG date, PEG complications, prior history of abdominal surgery, shunt failure, etiology of shunt failure, date of shunt failure, shunt revision, date of shunt revision, and follow-up. Data were separated into two groups: subjects with and those without shunt failure. Descriptive statistics were used.
Results: : Out of 21 patients (8F/13M), 4 experienced shunt failure, 17 did not. There was a significant difference between the Failed and Not-Failed group in the type of shunt inserted (p<0.01), with the former group receiving predominantly VPS (82.4%) and the latter receiving predominantly lumboperitoneal shunts (75.0%). The two groups also significantly differed in the presence of general surgery assistance during shunt insertion (p= 0.04), with the Failed group utilizing assistance in 50.0% of their cases, and the Not-Failed group in 94.1% of their cases. There were no significant differences in age (p=0.77), sex (p=0.54), etiology of hydrocephalus (0.12), complications during shunt insertion (0.06) or PEG insertion (0.56), the presence of previous abdominal surgery (p=0.44), or the relative timing of VPS-PEG insertion (p=0.69) between the two groups. As for shunt failure etiology, infection was responsible for 2/4 shunt failures, tip migration for 1/4 and coiling of the catheter for 1/4
Conclusions: The utilization of VPS shunt over lumboperitoneal shunt and the presence of general surgery assistance during shunt insertion were associated with lower shunt failure outcomes, while the age or sex of the patient, hydrocephalus etiology, presence of complications, prior abdominal surgery or relative timing of VPS-PEG insertion did not.
Patient Care: improve patient outcomes by decreasing the incidence of shunt failures, and thus need for repeat surgery, by investing the optimum relative timing of PEG-VPS insertion
Learning Objectives: 1) relative timing of VPS-PEG insertion had no effect on shunt failure 2) the type of shunt used and the presence of general surgery assistance were associated with lower shunt failure rates 3) Infection was responsible for the majority of shunt failure etiologies