Impact of Hospital Volume on Outcome After Surgical Treatment for Hydrocephalus: A U.S. Population Study From the National Inpatient Sample

Abstract

Introduction Hydrocephalus remains a common condition with significant patient morbidity; however, accurate accounting of the incidence of this disease as well as of the impact of hospital volume on outcome remains limited. Methods The National Inpatient Sample was used to evaluate patients who underwent surgical treatment of hydrocephalus from 2009-2013. Patient demographics (e.g., length of stay, disposition, charges), and the impact of hospital volume on outcomes were evaluated. Results A total of 156,205 patients were identified. Ventriculoperitoneal (VP) shunting the most common type of device (35.8%) followed by shunt replacement (23.9%). Treatment charges for hydrocephalus were $332 million in 2009 and $418 million in 2013 nationally. High-volume hospitals had more routine discharges compared with lower-volume hospitals (65.7% vs. 50.9%, p<0.0001), which was a trend that improved over time. Multivariate analysis confirmed that hospital volume was independently associated with routine disposition after adjusting for other factors such as patient age, length of stay, and shunt type. However, hospital volume showed a small association with length of stay (β =-0.05, p = 0.0001) and did not impact hospital charges on multivariate analysis. Conclusion This analysis provides a recent update of hydrocephalus epidemiology, trends, and outcomes nationally. Estimates from this study suggest that hydrocephalus is a common and costly problem. Hospital volume was for the first time to be associated with important differences in patient outcomes.

Consideration of Kinase Inhibitors for the Treatment of Hydrocephalus

“…The most common surgery is the placement of a shunt to redirect CSF from the brain to another body cavity for reabsorption. Shunts are prone to malfunction and infection and require additional, often repetitive, surgeries due to blockage, mechanical malfunction, or infection [ 23 , 24 , 25 , 26 , 27 ]. For example, in the pediatric population, 50% of shunts fail within the first 2 years [ 28 ].…”

“…This procedure involves the creation of a small opening in the third ventricle toward the subarachnoid space to create a bypass for CSF circulation from the ventricles to the subarachnoid space. A third type of intervention is ETV in conjunction with irreversible cauterization of the choroid plexus in the lateral ventricles in order to limit the amount of CSF produced [ 24 , 25 , 26 ].…”

Do P‐glycoprotein Medications Alter the Risk of Ventriculoperitoneal Shunt in Adults with Hydrocephalus?

“…It is common in infancy due to congenital malformations and in older people, most commonly as normal pressure hydrocephalus (NPH) 1,2 . Moreover, the overall treatment cost of hydrocephalus and related conditions remains high, estimated at around $8 billion annually in the United States alone 3 . The mean per‐patient cost of a ventriculoperitoneal (VP) shunt placement (Figure 1), the gold‐standard treatment for hydrocephalus, 4 is estimated at $150,000 3 …”

“…1,2 Moreover, the overall treatment cost of hydrocephalus and related conditions remains high, estimated at around $8 billion annually in the United States alone. 3 The mean per-patient cost of a ventriculoperitoneal (VP) shunt placement (Figure 1), the gold-standard treatment for hydrocephalus, 4 is estimated at $150,000. 3 Despite the immense burden of healthcare on patients and providers, hydrocephalus remains clinically under-recognized, 1 and its pathogenesis is yet to be adequately understood.…”

“…3 The mean per-patient cost of a ventriculoperitoneal (VP) shunt placement (Figure 1), the gold-standard treatment for hydrocephalus, 4 is estimated at $150,000. 3 Despite the immense burden of healthcare on patients and providers, hydrocephalus remains clinically under-recognized, 1 and its pathogenesis is yet to be adequately understood. Classical circulation theory stipulates that the cerebrospinal fluid (CSF) produced by the choroid plexus proceeds unidirectionally to be reabsorbed by the arachnoid granulations, with any obstruction to these pathways resulting in hydrocephalus.…”