The Rate of Complications after Ventriculoperitoneal Shunt Surgery

Abstract

Background: Although ventriculoperitoneal shunt (VPS) surgery is the most frequent surgical treatment for patients with hydrocephalus, modern rates of complications in adults are uncertain.

Methods: We performed a retrospective cohort study of adult patients hospitalized at the time of their first recorded procedure code for VPS surgery between 2005 and 2012 at nonfederal acute care hospitals in California, Florida, and New York. We excluded patients who during the index hospitalization for VPS surgery had concomitant codes for VPS revision, central nervous system (CNS) infection, or died during the index hospitalization. Patients were followed for the primary outcome of a VPS complication, defined as the composite of CNS infection or VPS revision. Survival statistics were used to calculate the cumulative rate and incidence rate of VPS complications.

Results: A total of 17,035 patients underwent VPS surgery. During a mean follow-up of 3.9 (± 1.8) years, at least 1 VPS complication occurred in 23.8% (95% confidence interval [CI], 22.9%-24.7%) of patients. The cumulative rate of CNS infection was 6.1% (95% CI, 5.7%-6.5%) and of VPS revision 22.0% (95% CI, 21.1%-22.9%). Most complications occurred within the first year of hospitalization for VPS surgery. Complication rates were 21.3 (95% CI, 20.6-22.1) complications per 100 patients per year in the first year after VPS surgery, 5.7 (95% CI, 5.3-6.1) in the second year after VPS surgery, and 2.5 (95% CI, 2.1-3.0) in the fifth year after VPS surgery.

Conclusions: Complications are not infrequent after VPS surgery; however, most complications appear to be clustered in the first year after VPS insertion.

Keywords: Brain abscess; Central nervous system infections; Epidemiology; Hydrocephalus; Neurosurgery; Ventriculoperitoneal shunts.

Conflict of interest statement

Conflicts of Interest: The authors report no conflicts of interest involving the work under consideration for publication. Outside the submitted work, Dr. Kamel has served on a medical advisory board and serves on a speakers bureau for Genentech. The other authors report no potential competing interests outside the submitted work.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Proportion of Patients with Ventriculoperitoneal Shunt Complications. Legend: Ventriculoperitoneal shunt complications are clustered within the first year after ventriculoperitoneal shunt insertion.