TY - JOUR

T1 - Forty years of shunt surgery at Rigshospitalet, Denmark

T2 - A retrospective study comparing past and present rates and causes of revision and infection

AU - Mansson, Philip Kofoed

AU - Johansson, Sofia

AU - Ziebell, Morten

AU - Juhler, Marianne

PY - 2017

Y1 - 2017

N2 - Objective The objective of this study is to review our experience of shunt surgery by investigating 40years of development in terms of rates of revision and infection, shunt survival and risk factors. Design and participants Medical records and operative reports were reviewed retrospectively for all patients who underwent primary shunt surgery at our department in the years 2010 to 2012. All results were compared with a previous study from our department. A mixed population consisting of 434 patients was included. Adults (≥15years) accounted for 89.9% of all patients and the mean follow-up time was 1.71years. Results Overall, 42.6% had a revision of which 65.4% fell within 6months postoperatively. Low age, high-risk diagnoses and less severe brain injury were associated with a higher risk of revision. One and 5-year shunt survival probabilities were 66.2% (61.5-70.9) and 48.0% (41.1-54.9). Within 4weeks postoperatively, 3.2% had an infection and overall infection rate was 5.5%. Short duration of surgery and the use of antibiotic prophylaxis were associated with a lower risk of infection. The most frequent causes of revision were valve defects (18.4%) and proximal defects or obstructions (15.7%). Compared to the previous study, no convincing improvement was found with regard to the revision rate (42.6% vs 48.3%, p 0.060) or overall infection rate (5.5% vs 7.4%, p 0.261). Conclusions Regardless of changes in patient demographics, techniques and equipment, risk of revision and infection still constitutes a major challenge in shunt surgery. The absence of convincing improvements calls for more studies concerning strategies to reduce complications.

AB - Objective The objective of this study is to review our experience of shunt surgery by investigating 40years of development in terms of rates of revision and infection, shunt survival and risk factors. Design and participants Medical records and operative reports were reviewed retrospectively for all patients who underwent primary shunt surgery at our department in the years 2010 to 2012. All results were compared with a previous study from our department. A mixed population consisting of 434 patients was included. Adults (≥15years) accounted for 89.9% of all patients and the mean follow-up time was 1.71years. Results Overall, 42.6% had a revision of which 65.4% fell within 6months postoperatively. Low age, high-risk diagnoses and less severe brain injury were associated with a higher risk of revision. One and 5-year shunt survival probabilities were 66.2% (61.5-70.9) and 48.0% (41.1-54.9). Within 4weeks postoperatively, 3.2% had an infection and overall infection rate was 5.5%. Short duration of surgery and the use of antibiotic prophylaxis were associated with a lower risk of infection. The most frequent causes of revision were valve defects (18.4%) and proximal defects or obstructions (15.7%). Compared to the previous study, no convincing improvement was found with regard to the revision rate (42.6% vs 48.3%, p 0.060) or overall infection rate (5.5% vs 7.4%, p 0.261). Conclusions Regardless of changes in patient demographics, techniques and equipment, risk of revision and infection still constitutes a major challenge in shunt surgery. The absence of convincing improvements calls for more studies concerning strategies to reduce complications.

KW - Hydrocephalus

KW - NEUROSURGERY

U2 - 10.1136/bmjopen-2016-013389

DO - 10.1136/bmjopen-2016-013389

M3 - Journal article

C2 - 28093434

AN - SCOPUS:85010420477

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - e013389

ER -