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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 83-87
DOI: 10.4103/ajns.AJNS_216_19
Original Article

Ventriculoperitoneal shunt complication in pediatric hydrocephalus: Risk factor analysis from a single institution in Nepal

Prakash Paudel
1   Department of Neurosciences, Mediciti Hospital, Latitpur, Uttar Pradesh, India
2   Department of Neurosurgery, Bir Hospital, Kathmandu
,
Prakash Bista
2   Department of Neurosurgery, Bir Hospital, Kathmandu
,
Durga Pahari
3   Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu
,
Gopal Sharma
1   Department of Neurosciences, Mediciti Hospital, Latitpur, Uttar Pradesh, India
2   Department of Neurosurgery, Bir Hospital, Kathmandu
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Objective: Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedures. Complications due to shunt failure are associated with high morbidity and mortality. We report an analysis of risk factors for shunt failure in pediatric patients from a single institution in Nepal. Materials and Methods: A retrospective analytical study with prospective data was designed. All children younger than 15 years, with first time VP shunting, at a tertiary government hospital in Kathmandu during 2014-2017 were followed up. Association of independent variables with the primary outcome variable (complication of VP shunt) was analyzed using Chi-square test. Bivariate logistic regression was performed to identify unadjusted odds ratio (OR) with 95% confidence interval (CI). Multivariate logistic regression model was designed to calculate adjusted OR with 95% CI. Results: Of 120 patients, more than half (55.8%) of the patients were male. Mean age was 62.97 months. Maximum duration of follow-up was 30 months. Most common cause of hydrocephalus was congenital aqueductal stenosis (40.8%) followed by tumors (29.2%). Overall shunt complication was found in 26.7% (95% CI 19.0%–35.5%). Shunt infection was seen in 5% while malfunction without infection was found in 21.7%. Bivariate logistic regression showed duration of surgery more than 1 h (OR 2.67, 95% CI 1.11–6.42, P = 0.028) compared to 1 h or less, experienced surgeon (OR 0.37, 95% CI 0.16–0.89, P = 0.026) compared to residents, and emergency surgery (OR 3.97, 95% CI 1.69–9.29, P = 0.001) compared to elective surgery as significant risk factors, while emergency surgery was the only significant variable for shunt failure on multivariate regression analysis (OR 3.3, 95% CI 1.16–9.35, P = 0.025). Conclusion: Longer duration of surgery, less experience of the surgeon, and the priority of the case (emergency) were independent risk factors for shunt complications.

Key-words:

Hydrocephalus - infection - malfunction - pediatric - shunt

Financial support and sponsorship

Nil.




Publication History

Received: 12 July 2019

Accepted: 23 December 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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