title: Risk of failure in pediatric ventriculoperitoneal shunts placed after abdominal surgery.
abstract: OBJECTIVE Experience has led us to suspect an association between shunt malfunction and recent abdominal surgery, yet information about this potential relationship has not been explored in the literature. The authors compared shunt survival in patients who underwent abdominal surgery to shunt survival in our general pediatric shunt population to determine whether such a relationship exists. METHODS The authors performed a retrospective review of all cases in which pediatric patients underwent ventriculoperitoneal shunt operations at their institution during a 7-year period. Survival time in shunt operations that followed abdominal surgery was compared with survival time of shunt operations in patients with no history of abdominal surgery. Univariate and multivariate analyses were used to identify factors associated with failure. RESULTS A total of 141 patients who underwent 468 shunt operations during the period of study were included; 107 of these 141 patients had no history of abdominal surgery and 34 had undergone a shunt operation after abdominal surgery. Shunt surgery performed more than 2 weeks after abdominal surgery was not associated with time to shunt failure (p = 0.86). Shunt surgery performed within 2 weeks after abdominal surgery was associated with time to failure (adjusted HR 3.6, 95% CI 1.3-9.6). CONCLUSIONS Undergoing shunt surgery shortly after abdominal surgery appears to be associated with shorter shunt survival. When possible, some patients may benefit from shunt placement utilizing alternative termini.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Burks
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Conner
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Briggs
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Glenn
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Bonney
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Cheema
authors.affiliation: Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Sixia
authors.initials: S
authors.lastname: Chen
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Naina L
authors.initials: NL
authors.lastname: Gross
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Mapstone
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D017287:Ventriculoperitoneal Shunt
keywords: PEG = percutaneous endoscopic gastrostomy; VP = ventriculoperitoneal; abdominal; failure; hydrocephalus; malfunction; pediatric; percutaneous endoscopic gastrostomy; shunt; surgery; ventriculoperitoneal