The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery

Venable, Garrett T.; Rossi, Nicholas; Jones, G. Morgan; Khan, Nickalus R.; Smalley, Zachary; Roberts, Mallory L.; Klimo, Paul

doi:10.3171/2015.12.peds15388

Cited by 31 publications

(14 citation statements)

References 54 publications

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“…Within the subset of our unplanned reoperations, the majority (73.5%) were shunt related. Recently, Venable et al 13 attempted to refine the analysis of shunt-related reoperations by focusing on the "Preventable Shunt Revision Rate." Preventable failure included infection, a malpositioned proximal or distal catheter, or an inadequately secured valve.…”

Section: Areas For Improvementmentioning

confidence: 99%

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

Roy

Chu

Bozeman

et al. 2017

PED

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OBJECTIVEVarious indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery.METHODSBetween May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations.RESULTSCerebrospinal fluid shunt–and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43–2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32–2.96, p < 0.05]).CONCLUSIONSApproximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When reoperations were unplanned, contributing factors could be both surgeon related and system related. Further study is required to determine the extent to which these reoperations are preventable. The utility of unplanned reoperation as a quality indicator is dependent on proper definition, analysis, and calculation.

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Section: Areas For Improvementmentioning

confidence: 99%

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

Roy

Chu

Bozeman

et al. 2017

PED

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“…It has been proposed that the preventable shunt revision rate could be a quality metric used for external comparison in the pediatric population. [ 23 24 25 ] In the adult population, the preventable unplanned shunt implantation return rate has also been proposed as a possible external comparison quality metric. [26] Reviewing the literature on UROR related to CSF diversion, Mukerji et al [13] and Roy et al [12] previously reported that shunt-related procedures accounted for 44% and 40.8% of all pediatric procedures at their study institutions, respectively.…”

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement

et al. 2021

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The unplanned return to the operating room rate is a quality metric for assessing hospital performance. This study aimed to evaluate the cause, incidence, and time interval of unplanned returns in index neurosurgical procedures within 30 days of the initial surgery as an internal audit. We retrospectively analyzed neurosurgical procedures between January 2015, and December 2019, in a single regional hospital. The definition of an unplanned return to the operating room was a patient who underwent two operations within 30 days when the second procedure was not planned, staged, or related to the natural course of the disease. A total of 4365 patients were identified in our analysis, of which 93 (2%) had an unplanned return to the operating room within 30 days of their initial surgery during admission. The most common reason for an unplanned return to the operating room for a cranial procedure was hemorrhage, followed by hydrocephalus and subdural effusion, which accounted for 49.5%(46/93), 12%(11/93), and 5.4%(5/93) of cases, respectively. In spinal procedures, the most common cause of return was a residual disc, followed by surgical site infection, which accounted for 5.4%(5/93) and 4.3%(4/93) of cases, respectively. The overall median time interval for unplanned returns to the operating room was 3 days (interquartile range, 1–9). Lowering the rate of postoperative hemorrhage in cranial surgery and postoperative residual disc in spine surgery was crucial as an internal audit in a 5-year single institute follow-up. However, the unplanned reoperation rate is less helpful in benchmarking because of the heterogeneity of patients between hospitals.

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“…Venable GT et al 15 reviewed 525 patients with 927 shunt insertion or revision surgeries. They studied risk factors comparing preventable and non-preventable causes.…”

Section: All the Included Patients Required One Or More Shuntmentioning

confidence: 99%

Patterns and prognosis of Ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia

Altwejri

AlRaddadi

Alsager

et al. 2020

NSJ

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Objectives: To examine the predictors of pediatric ventriculoperitoneal)VP(shunt malfunction in a university hospital. Methods: A retrospective cohort was conducted. Patients under 18 years old who underwent VP shunt revision at least once between 2016 and 2019 were included. Data were stratified based on age, gender, diagnosis, type of valve, valve position, cause of revision, and part revised. Results: A total of 45 patients)64% males and 36% females(were included in this study. Eighty-two revision surgeries were identified. The most common revised part was the entire shunt system. The most Original Article common type of valve which required revision was the low-pressure valve)15.5%(. Since a p-value of less than 0.05 was considered significant, no significant differences among the 4 groups for different points. Conclusions: Younger age at initial VP shunt insertion is associated with a higher rate of shunt malfunction. Valve mechanical failures followed by infections are the most common causes for the first 3 revisions. A prospective multi-center study to confirm the current findings is recommended.

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The Preventable Shunt Revision Rate: a potential quality metric for pediatric shunt surgery

Cited by 31 publications

References 54 publications

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement

Patterns and prognosis of Ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia

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