Introduction: Ventricular shunts are a common treatment for hydrocephalus in adults. Shunt-related complications, including infection and shunt failure, are major sources of hospital readmission, but the extent of this problem is difficult to measure with existing datasets.
Methods: The Nationwide Readmission Database (NRD) is a novel compilation of geographically distributed state databases that facilitates readmission analyses over a calendar year. Patients receive a de-identified linkage number to identify any readmission within the index state. We defined an index population of all adults undergoing new ventricular shunt placement between 2010-2014. We evaluated patient and hospital-level factors in univariate and multivariable analysis.
Results: Analysis identified 24,492 index admissions. The rate of all-cause readmissions was 16.5% within 30 days and 28.8% within 90 days. 9.2% required shunt revision within six months. The cost of hospitalizations for initial shunt placement was USD$3.8 billion. The cost of readmissions within 90-days was USD$432.8 million. 25.3% were readmitted at a different hospital. In multivariable analysis, patients with Medicare (OR 1.23, 1.10-1.38), traumatic brain injury (OR 1.28, 1.03-1.59), extracranial infection (OR 1.40, 1.28-1.54), brain tumor (1.60, 1.46-1.75), or a craniotomy on index hospitalization (OR 1.10, 1.00-1.22) were more likely to be readmitted. Patients aged 19-44 (OR 2.28, 1.77–2.93) and 45-64 (OR1.77, 1.40-2.24) were more likely to need shunt revision within six months than patients aged = 75. Patients with ventriculopleural shunts were more likely to need revision (OR 1.95, 1.24–3.04), while those who had non-traumatic intracranial hemorrhage were less likely to need revision (OR 0.66, 0.55-0.80).
Conclusions: All-cause readmission rates after shunt placement are high. More than one quarter of readmissions may be missed by prior reports. Multiple novel patient factors associated with readmission and shunt revision were identified. Efforts to reduce shunt revision and readmission should consider these factors
Patient Care: By illustrating which demographic factors are associated with readmission, our research aims to guide management of newly shunted adults to reduce complications and improve patient outcomes.
Learning Objectives: 1. Understand that all-cause readmission rates remain high for adult patients newly shunted in the setting of hydrocephalus.
2. Identify demographic factors, such as insurance status and age, as predictors of 30-day readmission.
3. Identify patients shunted in the context of specific etiologies, such as intracranial tumors and extracranial infections, as more likely to be readmitted.