title: Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision.
abstract: BACKGROUND
  Ventriculoperitoneal (VP) shunt placement, the mainstay of treatment for hydrocephalus, can place a substantial burden on patients and health care systems because of high complication and revision rates. We aimed to identify factors associated with 30-day VP shunt failure in children undergoing either initial placement or revision.
  
  
  METHODS
  VP shunt placements performed on patients in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric were identified.
  
  
  RESULTS
  VP shunts were placed in 3,984 patients either as an initial placement (n = 1,093) or as a revision (n = 2,891). Compared to the initial-placement group, the revision group was significantly more likely to experience shunt failure (14 vs. 8%, p < 0.0001). In the initial-placement group, congenital hydrocephalus was independently associated with shunt failure (OR 1.83; 95% CI 1.01-3.31, p = 0.047). In the revision group, cardiac risk factors (OR 1.38; 95% CI 1.00-1.90, p = 0.047), a chronic history of seizures (OR 1.33; 95% CI 1.04-1.71, p = 0.022), and a history of neuromuscular disease (OR 0.61; 95% CI 0.41-0.90, p = 0.014) were independently associated with shunt failure.
  
  
  CONCLUSIONS
  Identifying the factors associated with VP shunt failure may allow the development of interventions to decrease failures. Further refinement of the collected variables in the NSQIP Pediatric specific to neurosurgical procedures is necessary to identify modifiable risk factors.
authors.affiliation: Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Dani O
authors.initials: DO
authors.lastname: Gonzalez
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.forename: Lindsey
authors.initials: L
authors.lastname: Asti
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Ambeba
authors.forename: Brian
authors.initials: B
authors.lastname: Kenney
authors.forename: Lance
authors.initials: L
authors.lastname: Governale
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects* / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000639:trends