Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters.
BACKGROUND
The average hospital cost for shunt infection treatment is $50,000, making it the most financially costly implant-related infection in the United States. We set out to determine whether introduction of antibiotic-impregnated shunts (AISs) in our practice has decreased the incidence of shunt infection or decreased infection-related hospital costs at our institution.


METHODS
Clinical and hospital billing records of pediatric patients undergoing cerebrospinal fluid (CSF) shunt insertion at a single institution from April 2001 to December 2006 were retrospectively reviewed. Eighteen months before October 2002, all CSF shunts included standard, non-AIS catheters. During the 4 years after October 2002, all CSF shunts included AIS catheters. Patients were followed at least 18 months after surgery.


RESULTS
A total of 406 pediatric patients underwent 608 shunt placement procedures (400 AISs, 208 non-AISs). Of patients with non-AIS catheters, 25 (12%) experienced shunt infection, whereas only 13 patients (3.2%) with AIS catheters experienced shunt infection during follow-up (P < .001). The total hospital cost to treat 25 non-AIS shunt infections over the first 18 months was $1,234,928. The total hospital cost to treat 13 AIS shunt infections over the past 4 years was $606,328. The mean hospital cost per shunt infection was similar for infected AIS and non-AIS catheters ($46,640 vs. $49,397). However, the infection-related hospital cost per 100 patients shunted was markedly lower in the AIS cohort than in the non-AIS cohort ($151,582 vs. $593,715).


CONCLUSIONS
The introduction of AIS catheters in our institutional practice reduced the incidence of shunt infection and resulted in significant hospital cost savings. AIS systems are efficient and cost-effective instruments to prevent perioperative colonization of CSF shunt components.
Attenello
Frank J
FJ
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21237, USA.
Garces-Ambrossi
Giannina L
GL
Zaidi
Hasan A
HA
Sciubba
Daniel M
DM
Jallo
George I
GI
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics; D016459:Prosthesis-Related Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents