title: Surgical outcome of the shunt: 15-year experience in a single institution.
abstract: OBJECTIVE
  Surgical outcome after shunt insertion in pediatric hydrocephalus can vary greatly. Although first shunt survival rates and complications have been studied by several teams, much less is known about survival and complications of subsequent systems. The goals of this study were to evaluate the surgical outcome in a series of pediatric patients followed for a long time and establish the differences between first and subsequent extracranial shunt survival and complications.
  
  
  METHODS
  We undertook a retrospective study in pediatric patients treated with ventriculoperitoneal shunts between 2000 and 2015 at our institution. Surgical outcome was assessed, and different shunt survival curves were studied with Kaplan-Meier. Complications related to each shunt failure were examined and compared.
  
  
  RESULTS
  A total of 166 patients underwent 425 procedures, with a mean follow-up period of 93 months. The median number of shunt revision surgeries was 2. Shunt survival rates were better with the first shunt compared to those with the subsequent shunts. The main complication necessitating system revision surgery was overdrainage, the frequency of proximal and distal dysfunctions was similar in all the shunt failures, and isolated ventricle and infection were more frequent in younger patients. Shunt-related infections accounted for 7 % of the procedures, and the shunt independence rate was 10 %.
  
  
  CONCLUSIONS
  The frequency of complications related to shunt failure in pediatric patients changes during follow-up. A strict protocol of overdrainage detection and active treatment could explain the need for repeat surgeries and the progressively shorter shunt survival time in our series.
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain. siglesias95@yahoo.es.
authors: Sara
authors: http://orcid.org/0000-0002-2572-5513
authors: S
authors: Iglesias
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Bienvenido
authors: B
authors: Ros
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Álvaro
authors: Á
authors: Martín
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Antonio
authors: A
authors: Carrasco
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Miguel
authors: M
authors: Segura
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Andrea
authors: A
authors: Delgado
authors: Department of Statistics, Universidad de Málaga, Málaga, Spain.
authors: Francisca
authors: F
authors: Rius
authors: Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors: Miguel Ángel
authors: MÁ
authors: Arráez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Complications; Outcomes; Overdrainage; Pediatric hydrocephalus; Ventriculoperitoneal shunt