title: The burden and risk factors of ventriculostomy occlusion in a high-volume cerebrovascular practice: results of an ongoing prospective database.
abstract: OBJECT Ventriculostomy occlusion is a known complication after external ventricular drain (EVD) placement. There have been no prospective published series that primarily evaluate the incidence of and risk factors for EVD occlusion. These phenomena are investigated using a prospective database. METHODS An ongoing prospective study of all patients undergoing frontal EVD placement in the Neurosurgery Intensive Care Unit at the University of Florida was accessed for the purposes of this analysis. Demographic, procedural, and radiographic data were recorded prospectively and retrospectively. The need for catheter irrigation or replacement was meticulously documented. Univariate and multivariate regression analyses were performed. RESULTS Ninety-eight of 101 total enrolled patients had accessible data, amounting to 131 total catheters and 1076 total catheter days. Nineteen percent of patients required at least 1 replacement. Forty-one percent of catheters developed at least 1 temporary occlusion, with an average of 2.4 irrigations per patient. Intracranial hemorrhage occurred in 28% of patients after the first EVD placement (2% resulting in new neurological deficit) and in 62% of patients after 1 replacement. The cost of occlusion is estimated at $615 per enrolled patient. Therapeutic anticoagulation and use of small EVD catheters were statistically significant predictors of permanent occlusion (p = 0.01 and 0.04, respectively). CONCLUSIONS EVD occlusion is frequent and imparts a significant burden in terms of patient morbidity, physician upkeep, and cost. This study suggests that developing strategies or devices to prevent EVD occlusion, such as the preferential use of larger diameter catheters, may be beneficial in reducing the burden associated with ventriculostomy malfunction.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Dan
authors.initials: D
authors.lastname: Neal
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Timothy
authors.initials: T
authors.lastname: O'connor
authors.affiliation: Pathology and Laboratory Medicine, University of Florida, Gainesville, Florida.
authors.forename: Marie
authors.initials: M
authors.lastname: Rivera-Zengotita
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Gregory J A
authors.initials: GJ
authors.lastname: Murad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D004868:Equipment Failure / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D019233:Retreatment / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014696:Ventriculostomy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D055815:Young Adult
keywords: EVD = external ventricular drain; FoM = foramen of Monro; ICH = intracranial hemorrhage; ICU = intensive care unit; IVH = intraventricular hemorrhage; external ventricular drain; hydrocephalus; irrigation; occlusion; subarachnoid hemorrhage; vascular disorders; ventriculostomy