Endoscopic third ventriculostomy inpatient failure rates compared with shunting in post-hemorrhagic hydrocephalus of prematurity

Luther, Evan; McCarthy, David; Sedighim, Shaina; Niazi, Toba

doi:10.1007/s00381-019-04465-w

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…The weighted Elixhauser comorbidity index was calculated in a manner similar to previous works. [10][11][12][13][14][15]17,18 Outcomes for TCAR, CEA, and CAS were compared using a multivariate logistic regression model with covariates assessed to be clinically relevant, including age, sex, race, hospital teaching status, symptomatic carotid disease status, side of procedure, intraoperative monitoring, and weighted Elixhauser comorbidity score. For subgroup analysis, patients were propensity matched with the same covariates as above, using the k-nearest neighbor algorithm, and with 1:3 matching.…”

Section: Discussionmentioning

confidence: 99%

“…This schema is similar to that of previously published works. [7][8][9][10][11][12][13][14][15] Patients were excluded if they received more than one type of procedure or if the hospital teaching status, age, or survey weight variable was missing (less than 3% of originally queried patients were excluded on the basis of these criteria).…”

Section: Definition Of Cases and Outcomesmentioning

confidence: 99%

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Perioperative Outcomes in Transcarotid Artery Revascularization Versus Carotid Endarterectomy or Stenting Nationwide

Ramsay,

Burks,

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Transcarotid artery revascularization (TCAR) is a newer treatment for carotid stenosis where the carotid artery is accessed directly in the neck for stenting. It is less invasive than carotid endarterectomy (CEA) and has less embolic potential than carotid artery stenting (CAS), but population-level utilization of TCAR and outcomes are currently unknown. Our study compares outcomes of TCAR with those of CEA and CAS. METHODS: The National Inpatient Database was used for years 2015 to 2019. A multivariate logistic regression model was used to compare CEA, CAS, and TCAR outcomes with age, sex, race, hospital teaching status, symptomatic carotid disease status, side of procedure, intraoperative monitoring, and the weighted Elixhauser comorbidity score as covariates. RESULTS: TCAR comprised 0.69% of these procedures in 2016, rising to 1.35% in 2019. The inpatient rates of death, stroke, and myocardial infarction for TCAR were 0.63% (95% confidence interval: 0.36%, 1.06%), 0.42% (0.21%, 0.80%), and 1.46% (1.04%, 2.05%), respectively. Compared with CEA, TCAR had statistically insignificant difference odds of death, odds ratio (95% CI) for stroke was 0.47 (0.25, 0.87), and for myocardial infarction, it was 0.66 (0.37, 0.94). Compared with CAS, for TCAR, the odds ratio for death was 0.41 (0.24, 0.71), and for stroke, it was 0.48 (0.26, 0.91). CONCLUSION: TCAR is underutilized relative to other revascularization techniques yet has favorable outcomes compared with CEA and CAS. TCAR may be preferred to CAS in patients not surgical candidates for CEA and has a less invasive possibility for those eligible for CEA.

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Section: Discussionmentioning

confidence: 99%

Section: Definition Of Cases and Outcomesmentioning

confidence: 99%

Perioperative Outcomes in Transcarotid Artery Revascularization Versus Carotid Endarterectomy or Stenting Nationwide

Ramsay,

Burks,

et al. 2023

Operative Neurosurgery

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“…One large retrospective study found no association between gestational age or birth weight and the likelihood of ETV failure in a large PHHP cohort. 19 Conversely, another study investigating the use of ETV in PHHP found that weight less than 3 kg or age younger than 3 months at surgery were associated with increased ETV failure rates. 20 It is possible that the literature surrounding PHHP is more likely to include weight because prematurity is part of the pathophysiology of PHHP, and weight is commonly studied in premature cohorts.…”

Section: Age Versus Weightmentioning

confidence: 97%

Weight Predicts ETV Success in Pediatric Hydrocephalus Patients

Black,

Succop,

Stuebe

et al. 2023

Preprint

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Objective: The use of endoscopic third ventriculostomy (ETV) for treatment of pediatric hydrocephalus has higher failure rates in younger patients, notably less than 2.5 months of age. Here we investigated the impact of select perioperative variables, specifically gestational age, chronological age, birth weight, and surgical weight, on ETV failure rates. Methods: A retrospective review was performed on patients treated with ETV/CPC from 2010 to 2021 at a large academic center. Analyses included Cox regression for independent predictors and Kaplan-Meier survival curves for time to-event outcomes. Results: 47 patients underwent ETV/CPC at our institution. Overall, 65.6% of the cohort experienced ETV failure with a median failure onset of 36 days postoperatively until failure occurred. Univariate Cox regression analysis showed weight at the time of ETV surgery was significantly inversely associated with ETV failure with a hazard ratio of 0.92 (95% CI 0.82, 0.99). Multivariate analysis redemonstrated the inverse association of weight at time of surgery with ETV failure with hazard ratio of 0.76 (95% CI 0.60, 0.92) The associated ROC had an area under the curve of 0.7490 (95% CI 0.61, 0.89, p=0.02) demonstrating moderate validity in the value of surgery weight as a predictor for ETV failure. The weight cutoff with highest AUC was 4.9 kg (sensitivity: 74% specificity: 69%). Conclusions: Low weight at time of surgery can be an independent predictor of ETV/CPC failure. Previous studies assessing the relationship between ETV/CPC failure and age may have been confounded by not accounting for surgical weight.

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“… 1 17 18 20 A large percentage of the literature states that PHH is significantly associated with increased failure rates for ETV. 5 9 10 14 16 Luther et al 20 and Bock et al 18 recently described a positive association between the level of IVH and shunt failure, which was not shown for ETV. One hypothesis for this correlation is the fact that high-grade IVH may lead to proteinaceous and cellular debris, which may obstruct implanted catheters.…”

mentioning

confidence: 98%

“…Diverse findings in this field demonstrate that the mechanisms of CSF dynamics are still not well understood and indicate that the indications for both procedures, VP shunting and ETV, should be carefully considered in this particular age group. 20 …”

mentioning

confidence: 99%

Endoscopic third ventriculostomy: a feasible treatment option for pediatric hydrocephalus in a high-risk cohort – a single-center report

Deininger

Küppers

Lehnick

et al. 2022

World Jnl Ped Surgery

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Endoscopic third ventriculostomy inpatient failure rates compared with shunting in post-hemorrhagic hydrocephalus of prematurity

Cited by 8 publications

References 35 publications

Perioperative Outcomes in Transcarotid Artery Revascularization Versus Carotid Endarterectomy or Stenting Nationwide

Perioperative Outcomes in Transcarotid Artery Revascularization Versus Carotid Endarterectomy or Stenting Nationwide

Weight Predicts ETV Success in Pediatric Hydrocephalus Patients

Endoscopic third ventriculostomy: a feasible treatment option for pediatric hydrocephalus in a high-risk cohort – a single-center report

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