A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children.
ABSTRACT To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children.
A retrospective, longitudinal cohort of 1307 children ages 0 to 18 years undergoing initial ventricular shunt placement in the year 2000, with follow-up through 2005, from 32 freestanding children's hospitals within the Pediatric Health Information Systems database was studied. Rates of ventricular shunt revision were compared with patient demographic, clinical, and hospital characteristics with use of bivariate and multivariate regression accounting for hospital clustering.
Thirty-seven percent of children required at least one shunt revision within 5 years of initial shunt placement; 20% of children required two or more revisions. Institutional rates of first shunt revision ranged from 20 to 70% of initial shunts placed among the 32 hospitals in the cohort. Hospitals where one to 20 initial shunt placements per year experienced the highest initial shunt revision rate (42%). Hospitals performing over 83 initial shunt placements per year experienced the lowest revision rate (22%). We found that children undergoing shunt placement in the Midwest were more likely to experience multiple shunt revisions (odds ratio, 1.25; 95% confidence interval, 1.06-1.47) after controlling for hospital volume, shunt type, age, and diagnosis associated with initial shunt placement.
Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.
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ABSTRACT: Introduction Hospital readmission rates are used as a metric of the quality of patient care in adults. Readmission data is lacking for pediatric surgical patients. The objective of this study is to evaluate our institution’s 30-day unexpected pediatric surgical readmission data to identify potentially preventable readmissions. Methods An internal database of all pediatric surgical 30-day readmissions to two tertiary-referral children’s hospitals in a single health system was reviewed. All pediatric general surgery admissions between January 2008 and May 2013 with hospital readmission within 30 days were included in the study. Patient demographics, diagnoses, cause of readmission, procedure performed, and length of stay were recorded. Charts were individually reviewed to evaluate causality of readmission. Results There were 2217 pediatric general surgery admissions during the study period. Of these, 145 (6.5 %) experienced unexpected readmission within 30 days. One-third of all readmissions occurred in infants between 0 and 364 days of age, 50 % occurred in those under 2 years and wholly 80 % of all readmissions occurred in those under 9 years of age. A majority of readmissions were associated with chronic comorbid conditions. Conclusion Analysis of pediatric surgical readmission data may assist hospitals in focusing quality of care and cost effectiveness strategies. Development of coordination of care strategies and discharge planning involving both pediatric surgical teams and pediatric hospitalists/specialists may reduce pediatric surgical readmission rates.Pediatric Surgery International 04/2015; 31(6). DOI:10.1007/s00383-015-3701-4 · 1.06 Impact Factor
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ABSTRACT: Ventriculoperitoneal shunting (VPS) is a widely accepted technique for the treatment of hydrocephalus. The probability of shunt dysfunction is pretty high throughout life. Laparoscopy has become a valuable tool to perform VPS and treat abdominal complications. An electronic literature search was performed to reveal the published data relating laparoscopy and ventriculoperitoneal shunt in Medline, Embase, Scielo and Lilacs databases. The keywords employed were "laparoscopy" OR "laparoscopic surgery" AND "ventriculoperitoneal shunt" OR "shunt" AND "surgery" OR "implantation" OR "revision" OR "complication". No high quality trials were developed comparing conventional laparotomic incision vs laparoscopic approach. Both approaches have evolved and currently there are less invasive options for laparotomy, like periumbilical small incisions; and for laparoscopy, like smaller and less incisions. Operating room time, blood loss and hospital stay may be potentially smaller in laparoscopic surgery and complications are probably the same as laparotomy. In revision surgery for abdominal complications after VPS, visualization of whole abdominal cavity is fundamental to address properly the problem and laparoscopic approach is valuable once it is safe, fast and much less invasive than laparotomy. Ventriculoperitoneal shunting is a widely accepted technique for the treatment of hydrocephalus. Laparoscopy assisted shunt surgery in selected cases might be a less invasive and more effective option for intrabdominal manipulation. The laparoscopic approach allows a better catheter positioning, lysis of fibrotic bundles and peritoneal inspection as well, without any additional complication.09/2014; 6(9):415-8. DOI:10.4253/wjge.v6.i9.415
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ABSTRACT: Introduction The optimal surgical treatment for symptomatic middle fossa arachnoid cyst is still controversial. The most leading therapeutic options include cyst shunting and fenes-tration (endoscopic, microsurgical). We present our experi-ence on surgical treatments of arachnoid cysts. Patients and methods A retrospective data review of 16 chil-dren who underwent keyhole craniotomy for microsurgical fenestration and shunting of middle fossa arachnoid cysts between 1999 and 2012 was performed after institutional review board approval. The average patient age was 6.1 years. The average follow-up period was 36.5 months. There were ten male and six female patients in the series. Indications for surgery included intractable headaches (50 %), increasing in cyst size (18.75 %), and seizures (31.25 %). All patient records were reviewed for their clinical presentation, classifi-cation, cyst resolution, symptom resolution, and cyst out-comes. After surgery, all patients underwent assessments of clinical and radiological improvement. Results Postoperative complications were observed in two cases: progressively resolving monoparesia in one case and resolving epileptic seizure with monotherapy in the other. All patients had a satisfactory clinical outcome, and in 87.5 %, there was either a decrease in the size or a complete disap-pearance of the MFAC. Nevertheless, three (18.75 %) of all patients needed shunt revision because of shunt dysfunction. Complication related to surgical technique was cerebrospinal fluid leak which spontaneously resolved in one patient. Conclusion Microsurgical fenestration with keyhole craniot-omy to provide passage between cysts to basal cisterns to-gether with cystoperitoneal shunting during the same opera-tion is still an effective and safe method in cases with symp-tomatic middle fossa arachnoid cysts in children.