title: A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children.
abstract: OBJECTIVE
  To identify factors influencing the duration of cerebrospinal fluid shunt survival after initial placement and after subsequent revisions.
  
  
  METHODS
  We conducted a retrospective cohort study using the Pediatric Health Information System database, which contains resource use data from 37 tertiary care children's hospitals. Children younger than 18 years who underwent initial cerebrospinal fluid placement between January 1, 2000, and December 31, 2005, were eligible.
  
  
  RESULTS
  During the study period, 20.2, 7.5, and 6.9% of 7399 patients required one, two, or three or more shunt revisions, respectively. Shunt survival rates were lower with each subsequent shunt revision. In multivariable Cox proportional hazards analysis, children undergoing shunt placement in the Northeast census region had a longer duration of shunt survival between initial placement and both the first (adjusted hazard ratio, 0.74; 95% confidence interval, 0.55-0.99) and second (adjusted hazard ratio, 0.66; 95% confidence interval, 0.51-0.86) revisions. Young age and a principal diagnosis of obstructive hydrocephalus were also associated with a higher risk of failure after initial placement; age-related variation in shunt survival persisted after the first but not the second revision. Among patients with multiple shunt revisions, those with early revision (i.e., revision <60 d after placement) had a shorter shunt survival time after subsequent revisions (adjusted hazard ratio for second revision, 1.30; 95% confidence interval, 1.11-1.52).
  
  
  CONCLUSIONS
  Regional variation in the risk of ventricular shunt revision exists, and young infants are at the highest risk for shunt failure. Risk factors for the duration of shunt survival differ between the initial and subsequent revisions.
authors.affiliation: Department of Pediatrics and The Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. shahs@email.chop.edu
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Slonim
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hornig
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Vidya
authors.initials: V
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors