title: Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study.
abstract: OBJECTIVE
  Very long-term follow-up and outcome are rare for pediatric patients with hydrocephalus and shunt operations. The aim of this study was to determine the long-term mortality rates in these patients.
  
  
  METHODS
  Pediatric patients with first shunt operation between 1982 and 1992 were included. For each patient, time and cause of death were determined. Further, patients with first operation from 1982 to 1987 were compared to those first operated from 1988 to 1992.
  
  
  RESULTS
  One-hundred thirty-seven patients were included. Etiologies of hydrocephalus were intraventricular hemorrhage (31.4 %), meningomyelocele (25.5 %), postinfectious (11.7 %), congenital (10.2 %), posterior fossa cyst (8.8 %), aqueductal stenosis (8 %), and others (4.4 %). Overall, 53 patients (38.7 %) died. The percentage of patients surviving 1, 2, 10, and 20 years after first operation were 82.6, 73.6, 69.4, and 65.3 %, respectively. In 23 patients, the cause of death was related to shunt treatment: shunt infection was diagnosed in 18 and acute shunt dysfunction in 5 patients. Mortality was considerably higher for patients with their first operation in time period 1982-1987 compared to time period 1988-1992 (51 versus 25 %). The reduction of mortality was mainly due to an increased survival after shunt infection. Eighty-seven patients survived more than 20 years after initial shunt operation. Of those long-term survivors, three (3.4 %) patients died 22-24 years after first operation.
  
  
  CONCLUSIONS
  Mortality in hydrocephalic pediatric patients is high especially in the first postoperative years but is even significant in adult patients with pediatric hydrocephalus. As deaths occur even after 20 years, routine follow-up of long-term survivors remains necessary.
authors.affiliation: Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria. matthias.gmeiner@gespag.at.
authors.forename: Matthias
authors.identifier: http://orcid.org/0000-0002-7619-9330
authors.initials: M
authors.lastname: Gmeiner
authors.affiliation: Department of Applied Statistics, Johannes Kepler University, Linz, Austria.
authors.forename: Helga
authors.initials: H
authors.lastname: Wagner
authors.affiliation: Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Zacherl
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, Linz, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Polanski
authors.affiliation: Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Auer
authors.affiliation: Department of Neurosurgery, Vrije Universitet University Medical Centre Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willem J R
authors.initials: WJ
authors.lastname: van Ouwerkerk
authors.affiliation: Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality* / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
keywords: Long-term outcome; Mortality; Pediatric hydrocephalus; Shunt infection