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Purpose <p>To identify clinical variables associated with ventricular shunt infection and shunt failure in pediatric hydrocephalus.</p> Methods <p>Patients ≤ 18&#xa0;years treated with ventricular shunts between 2013 and 2024 were identified from one institution’s electronic medical record. Children with a confirmed diagnosis of hydrocephalus and ≥ 6&#xa0;months of postoperative follow-up were included. Primary and revision shunt surgeries were included. Records were manually reviewed for clinical variables. Statistical analyses were performed using R (version 4.2.3).</p> Results <p>The dataset included 474 surgeries, 146 primary and 328 revisions, undergone by 226 patients. Infection necessitating removal of a previously placed shunt occurred following 3.59% (17/474) of cases. Discharge in ≤ 4&#xa0;days had a 75% lower relative risk for infection compared to stays &gt; 4&#xa0;days (1.5% vs. 6% 100-day infection risk; <i>p</i> = 0.011). Patients who underwent revision surgeries for shunt infections were more likely to experience subsequent infections in the first 100&#xa0;days postoperatively than those revised for other causes (2.42% vs. 21.05%; <i>p</i> &lt; 0.0001). Patient characteristics associated with shunt failure during the 10-year study included younger age (median age: 2.23&#xa0;years in those with failure vs. 6.62&#xa0;years in those without; <i>p</i> &lt; 0.0002) and lower weight (median weight: 11.8&#xa0;kg vs. 20.3&#xa0;kg; <i>p</i> &lt; 0.0002) at the time of admission. Congenital hydrocephalus (OR = 1.86; <i>p</i> = 0.0045) and aqueductal stenosis (OR = 1.75; <i>p</i> = 0.025) were also associated with shunt failure.</p> Conclusions <p>Length of stay &gt; 4&#xa0;days and previous shunt infection are associated with an increased risk of infection after shunt surgery. These findings are important to consider when counseling pediatric patients and during postoperative monitoring.</p>

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Factors affecting infection risk and revision rates in shunted pediatric hydrocephalus: 10 years of data from a single academic center

  • 期刊论文

  • 发表日期：

    2025年10月21日

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  • Daniel N. de Souza,
  • Adhith Palla,
  • Rachel E. Yan,
  • Eric A. Grin,
  • Michael Farid,
  • Alexander Eremiev,
  • Caroline Kremer,
  • Zoran Z. Gajic,
  • Jeffrey H. Wisoff,
  • Eveline Teresa Hidalgo,
  • David H. Harter

摘要

Purpose

To identify clinical variables associated with ventricular shunt infection and shunt failure in pediatric hydrocephalus.

Methods

Patients ≤ 18 years treated with ventricular shunts between 2013 and 2024 were identified from one institution’s electronic medical record. Children with a confirmed diagnosis of hydrocephalus and ≥ 6 months of postoperative follow-up were included. Primary and revision shunt surgeries were included. Records were manually reviewed for clinical variables. Statistical analyses were performed using R (version 4.2.3).

Results

The dataset included 474 surgeries, 146 primary and 328 revisions, undergone by 226 patients. Infection necessitating removal of a previously placed shunt occurred following 3.59% (17/474) of cases. Discharge in ≤ 4 days had a 75% lower relative risk for infection compared to stays > 4 days (1.5% vs. 6% 100-day infection risk; p = 0.011). Patients who underwent revision surgeries for shunt infections were more likely to experience subsequent infections in the first 100 days postoperatively than those revised for other causes (2.42% vs. 21.05%; p < 0.0001). Patient characteristics associated with shunt failure during the 10-year study included younger age (median age: 2.23 years in those with failure vs. 6.62 years in those without; p < 0.0002) and lower weight (median weight: 11.8 kg vs. 20.3 kg; p < 0.0002) at the time of admission. Congenital hydrocephalus (OR = 1.86; p = 0.0045) and aqueductal stenosis (OR = 1.75; p = 0.025) were also associated with shunt failure.

Conclusions

Length of stay > 4 days and previous shunt infection are associated with an increased risk of infection after shunt surgery. These findings are important to consider when counseling pediatric patients and during postoperative monitoring.