Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review

Hasanain, Amr Ali; Abdullah, Ahmed; Alsawy, Mohamed F.; Soliman, Mohamed A.R.; Ghaleb, Ammar Ali; Elwy, Reem; Ezzat, Ahmed; Menabbawy, Ahmed Al; Marei, Ahmed A.; Razik, Bassante Abd El; Hamaky, Mostafa I. El; Schroeder, Henry W. S.; Fleck, Steffen; Damaty, Ahmed El; Marx, Sascha; Nowak, Stephan; Baldauf, Jörg; Zohdi, Ahmed; Refaee, Ehab Ahmed El

doi:10.1055/s-0038-1669464

Cited by 20 publications

(5 citation statements)

References 19 publications

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“…of patients with VP shunt infection were aged <2 years. Similar results were found in a study by Hasanain et al, [17] which showed that VP shunt failure was very common in infants, and that the most common cause of VP shunt failure in children <2 years was shunt infection. Many studies have described specific evidence reported from the literature suggesting that the risk of infection increases when extraventricular devices (EVDs) such as VP shunts are retained for >5 days [18] and >10 days.…”

Section: Researchsupporting

confidence: 90%

Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

et al. 2020

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Healthcare-associated infections, also known as nosocomial infections, which affect patients in a hospital or healthcare facility and were not present or incubating at the time of admission, [1] are among the main patient safety challenges in healthcare facilities. [2] They can be defined as an infection that develops 48 hours after hospital admission or within 48 hours after discharge. [3] In spite of improvements in healthcare, nosocomial infections continue and can be acquired anywhere healthcare is delivered, including inpatient acute-care hospitals, outpatient settings such as ambulatory surgical centres, end-stage renal disease facilities, and long-term care facilities such as nursing homes and rehabilitation centres. The development of nosocomial infections is dependent on two key pathophysiological factors: decreased host defences and colonisation by pathogenic or potentially pathogenic organisms. [4] A survey published by the New England Journal of Medicine (cited in Becker's Clinical Leadership and Infection Control [5]) provides important insight for healthcare providers in their efforts to combat infections, reporting prevalence of the five commonest recorded nosocomial infections as follows: pneumonia 21.8% of all healthcare-associated infections; surgical site infection (SSI) 21.8%; gastrointestinal infection 17.1%; urinary tract infection 12.9%; and primary bloodstream infection 9.9%. It is estimated that ~1 in 7 patients entering South African (SA) hospitals is at high risk of acquiring a nosocomial infection. [6] Neurosurgical patients are particularly vulnerable because of the serious nature of their illnesses, the frequency of associated trauma, and the presence of invasive devices. Neurosurgeons treat conditions such as aneurysms, stroke, epilepsy, meningitis, traumatic brain injury, spinal cord injury and brain tumours, all of which predispose patients to fungal, viral and bacterial infections. A study conducted in Pretoria, SA, reported that the incidence of ventriculitis reached 28.3% among paediatric neurosurgical patients. [7] Objectives Nelson Mandela Academic Hospital (NMAH) in Mthatha, like many hospitals in SA, [7] faces high rates of nosocomial infections. The present study sought to determine the aetiology and incidence of these infections following neurosurgical procedures, as well as the associated risk factors. Methods This was a descriptive cross-sectional study. Patients were enrolled from 1 October 2013 to 30 September 2014. All inpatients who had had a neurosurgical procedure at NMAH during the study period were included in the study if their medical and laboratory records were accurate, legible and complete. Medical records were accessed in the Department of Neurosurgery at NMAH where patients were admitted, while laboratory records were obtained from the Department of Medical Microbiology at the National Health This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Researchsupporting

confidence: 90%

Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

et al. 2020

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“…We also observe parallels with clear ndings of shunt infection and obstruction as key causes of shunt failures. The discrepancies might be attributed to the shunt system's intraoperative exposure period, the number of surgeons, or their skill set (19)(20)(21). In contrast, a study done in Iran found that the observed involvement of a junior surgical trainee during surgery was the major risk factor for VPS revisions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Causes and Early Outcomes of Shunt Revisions at a Tertiary Hospital in Tanzania

Machaku,

Rabiel,

Chilonga

2023

Preprint

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BACKGROUND The mainstay treatment for patients presenting with hydrocephalus is surgical, with VPS placement being a routine practice, especially in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident compounding to significant patient morbidity and mortality.METHODS This study was carried out at a tertiary hospital between March 2020 and March 2023. It includes 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for three months, at which time their characteristics in relation to shunt complications were evaluated. The SPSS version 26 was utilized for analyzing the data that had been gathered.RESULTS VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. The majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). SSI increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 minutes. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating to longer hospital stays.CONCLUSION The emphasis on long surgery durations and a surgeon's skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice from the index operation be enhanced to reduce complications. The findings of this study might serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.

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“…The VP shunt is a medical device that diverts excess CSF from the ventricles of the brain to the peritoneal cavity in the abdomen, where it can be reabsorbed by the body. [18,19] There are several types of VP shunts available, each with its own features and benefits.…”

Section: Shunts In the Management Of Hydrocephalusmentioning

confidence: 99%

An overview of hydrocephalus and shunts used in the clinical management of hydrocephalus

Jakiela,

Billavara,

Kaliaperumal

et al. 2023

Preprint

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<p>As hydrocephalus is a complex neurological condition with significant clinical implications, we believe that this review article is timely to provide a comprehensive overview of shunts used in neurosurgery. This article delves into the etiology, clinical presentation, and challenges associated with hydrocephalus, while focusing primarily on the surgical placement of shunt systems as a key management strategy. We believe that this review will offer valuable insights to clinicians and researchers involved in the management of hydrocephalus. It will provide an in-depth understanding of different shunt systems, their specific characteristics, and associated advantages and limitations, thus empowering clinicians to make informed decisions tailored to individual patients.</p>

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Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review

Cited by 20 publications

References 19 publications

Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

Postoperative infections: Aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa

Prevalence, Causes and Early Outcomes of Shunt Revisions at a Tertiary Hospital in Tanzania

An overview of hydrocephalus and shunts used in the clinical management of hydrocephalus

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