Ventriculoperitoneal shunt failure: an institutional review of 2-year survival rates.
OBJECTIVE
Prior research has examined predictors of shunt failure in children with hydrocephalus and concluded that the majority of shunts do not survive long-term. However, risk factors such as etiology, birth weight, and gestational age may vary across institutions and populations. We sought to identify the social, clinical, and neonatal factors associated with initial ventriculoperitoneal (VP) shunt failure in the intraventricular hemorrhage (IVH) patient population and the patient population with an etiology other than IVH (non-IVH).


METHODS
A retrospective review of patients, born during 2000-2005 diagnosed and treated for hydrocephalus at Children's of Alabama was conducted. Survival analysis identified factors associated with time to shunt failure.


RESULTS
Analyses were done separately for the IVH and non-IVH cohorts. Age and weight at initial VP shunt insertion were found to be associated with shunt failure in the non-IVH group (p < .05). Of the 238 patients in the non-IVH cohort, 108 failed within 2 years of their initial insertion. Fifty of those shunt failures occurred within 3 months of initial shunt placement. In the IVH cohort, 56 out of 100 failed within 2 years; 36 of those failed within 3 months post initial shunt insertion. When controlling for type of shunt failure, age at initial shunt placement was associated with time to shunt failure (p = .0004).


CONCLUSIONS
This study confirms previously published studies on the IVH population. A prospective cohort study and standardized clinical decision making are necessary to further assess the impact that shunting has on this patient population.
Division of Neurosurgery, Section of Pediatric Neurosurgery, Children's Hospital of Alabama, University of Alabama, 400 Ambulatory Care Center, 1600 7th Ave South, Birmingham, AL 35233, USA. chevis.shannon@childrensal.org
Chevis N
CN
Shannon
Leslie
L
Acakpo-Satchivi
Russell S
RS
Kirby
Frank A
FA
Franklin
John C
JC
Wellons
D000367:Age Factors; D000407:Alabama / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*