Ventriculoperitoneal Shunt and Gastrostomy Tube Placement and Timing: A Database Analysis

Abstract

Background Debate exists about the safety of ventriculoperitoneal shunt placement in the presence of a gastrostomy tube and the timing of these procedures from each other. Using a large database, we sought to determine the rates of shunt infection and revision in patients who had both devices placed, based on the timing between procedures. Methods We performed a retrospective database analysis using a multi-institutional database (TriNetX), looking at all patients diagnosed with gastrostomy tube with subsequent ventriculoperitoneal shunt placement and vice-versa. We also evaluated patients who had gastrostomy tubes and shunts placed at the same time. We categorized cohorts into patients with device placement after 1-10 days, 11-30 days, and after one month of the other. Our primary endpoints were shunt infection and shunt revision. Results Patients who had same-day gastrostomy tube and shunt placement had a shunt infection rate of 10.06% within five years, and 14.53% had a shunt revision. With prior shunting and subsequent gastrostomy tube placement within 1-10 days, 12.18% had shunt infections, and 17.88% had shunt revisions; for those who had subsequent gastrostomy tube placement within 11-30 days, shunt infections were seen in 10.57%, and shunt revisions in 19.41%; gastrostomy tube placement after one month or longer of shunt placement resulted in 15.39% of patients having shunt infections and 17.73% with shunt revision. Prior gastrostomy tube patients with subsequent shunt placement, within 1-10 days had shunt infection rates of 8.27% and revision rates of 14.39%; for shunt placement within 11-30 days, shunt infections were seen in 10.82%, and shunt revisions were done in 14.33% of patients; for shunt placement after one month or longer, shunt infection rate was 11.68%, and revision rate was 16.80%. Conclusions Our results demonstrate no significant difference in shunt infection rates and shunt revision rates between same-day gastrostomy tube and shunt placement versus placement within 1-10 days, 11-30 days, or any time after one month from one another.

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“…A 2022 retrospective study by Hallan and Rizk analyzed the rate of infection among 4,269 patients with a VPS and G-tubes in a retrospective database. The study reported no significant difference in infection or revision rates between the same-day G-tube and VPS placement when compared to placement within one to ten days, eleven to thirty days, or greater than one month [24].…”

“…It is common for VPS patients to require G-tubes for nutritional support, but complications may arise when the VPS catheter has already been implanted into the peritoneal cavity or from simultaneous placement. [24,25]. Placing a G-tube following a VPS increases the risk of infection and shunt malfunction [25].…”

“…Due to the increased risk of ascending meningitis, the presence of a VPS is a relative contraindication to gastrostomy placement [26]. However, there are no neurosurgical guidelines on the matter and controversy still surrounds whether the concurrent procedures are contraindicated [24,26,27].…”

Gastrostomy Sequence With Ventriculoperitoneal Shunting—Does It Matter?

“…The data on an ideal interval and sequence of gastrostomy and VPS placement to mitigate the risks of infection and revision are mixed and inconclusive for the adult population. [9][10][11][12][13]15,16,21 Perhaps the most notable study was conducted recently in 2022 by Hallan and Rizk. 16 Using a multi-institutional database (TriNetX), they evaluated 4269 patients categorized into cohorts of patients with varying procedure intervals.…”

“…[9][10][11][12][13]15,16,21 Perhaps the most notable study was conducted recently in 2022 by Hallan and Rizk. 16 Using a multi-institutional database (TriNetX), they evaluated 4269 patients categorized into cohorts of patients with varying procedure intervals. They found no significant difference in shunt infection or revision rates between intervals, including same day vs gastrostomy after VPS placement.…”