title: Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) may be complicated by hydrocephalus in 6.5%-67% of cases. Some patients with aSAH develop shunt dependency, which is often managed by ventriculoperitoneal shunt placement. The objectives of this study were to review published risk factors for shunt dependency in patients with aSAH, determine the level of evidence for each factor, and calculate the magnitude of each risk factor to better guide patient management. METHODS The authors searched PubMed and MEDLINE databases for Level A and Level B articles published through December 31, 2014, that describe factors affecting shunt dependency after aSAH and performed a systematic review and meta-analysis, stratifying the existing data according to level of evidence. RESULTS On the basis of the results of the meta-analysis, risk factors for shunt dependency included high Fisher grade (OR 7.74, 95% CI 4.47-13.41), acute hydrocephalus (OR 5.67, 95% CI 3.96-8.12), in-hospital complications (OR 4.91, 95% CI 2.79-8.64), presence of intraventricular blood (OR 3.93, 95% CI 2.80-5.52), high Hunt and Hess Scale score (OR 3.25, 95% CI 2.51-4.21), rehemorrhage (OR 2.21, 95% CI 1.24-3.95), posterior circulation location of the aneurysm (OR 1.85, 95% CI 1.35-2.53), and age ≥ 60 years (OR 1.81, 95% CI 1.50-2.19). The only risk factor included in the meta-analysis that did not reach statistical significance was female sex (OR 1.13, 95% CI 0.77-1.65). CONCLUSIONS The authors identified several risk factors for shunt dependency in aSAH patients that help predict which patients are likely to require a permanent shunt. Although some of these risk factors are not independent of each other, this information assists clinicians in identifying at-risk patients and managing their treatment.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Hai
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: M Yashar S
authors.initials: MY
authors.lastname: Kalani
authors.affiliation: Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, Oklahoma.
authors.forename: Yan D
authors.initials: YD
authors.lastname: Zhao
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
authors.affiliation: Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida.
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Mapstone
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D002557:Cerebrospinal Fluid Shunts; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000628:therapy*; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*
keywords: BCI = bicaudate index; EVD = external ventricular drain; Fisher grade; aSAH = aneurysmal subarachnoid hemorrhage; aneurysmal subarachnoid hemorrhage; cerebral aneurysm rupture; hydrocephalus; risk factors; shunt dependency; vascular disorders