The Rate of Complications after Ventriculoperitoneal Shunt Surgery.
BACKGROUND
Although ventriculoperitoneal shunt (VPS) surgery is the most frequent surgical treatment for patients with hydrocephalus, modern rates of complications in adults are uncertain.


METHODS
We performed a retrospective cohort study of adult patients hospitalized at the time of their first recorded procedure code for VPS surgery between 2005 and 2012 at nonfederal acute care hospitals in California, Florida, and New York. We excluded patients who during the index hospitalization for VPS surgery had concomitant codes for VPS revision, central nervous system (CNS) infection, or died during the index hospitalization. Patients were followed for the primary outcome of a VPS complication, defined as the composite of CNS infection or VPS revision. Survival statistics were used to calculate the cumulative rate and incidence rate of VPS complications.


RESULTS
A total of 17,035 patients underwent VPS surgery. During a mean follow-up of 3.9 (± 1.8) years, at least 1 VPS complication occurred in 23.8% (95% confidence interval [CI], 22.9%-24.7%) of patients. The cumulative rate of CNS infection was 6.1% (95% CI, 5.7%-6.5%) and of VPS revision 22.0% (95% CI, 21.1%-22.9%). Most complications occurred within the first year of hospitalization for VPS surgery. Complication rates were 21.3 (95% CI, 20.6-22.1) complications per 100 patients per year in the first year after VPS surgery, 5.7 (95% CI, 5.3-6.1) in the second year after VPS surgery, and 2.5 (95% CI, 2.1-3.0) in the fifth year after VPS surgery.


CONCLUSIONS
Complications are not infrequent after VPS surgery; however, most complications appear to be clustered in the first year after VPS insertion.
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA; Department of Neurology, Weill Cornell Medicine, New York, New York, USA; Department of Neurology, Columbia University Medical Center, New York, New York, USA. Electronic address: alm9097@med.cornell.edu.
Alexander E
AE
Merkler
Department of Neurology, Columbia University Medical Center, New York, New York, USA.
Judy
J
Ch'ang
Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA.
Whitney E
WE
Parker
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA; Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Santosh B
SB
Murthy
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA; Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Hooman
H
Kamel
D001922:Brain Abscess / Q000453:epidemiology / Q000601:surgery; D020806:Central Nervous System Bacterial Infections / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000706:statistics & numerical data
Brain abscess; Central nervous system infections; Epidemiology; Hydrocephalus; Neurosurgery; Ventriculoperitoneal shunts