Shunt outcomes following multidisciplinary ventriculoperitoneal shunt placement with general surgery involvement.
TL;DR
In a multicenter cohort, VPS placement with concurrent abdominal GS procedures was associated with lower 90-day VPS reoperation, conversion to alternative CSF diversion, and mechanical shunt complications, without increases in mortality, infection, or other 90-day complications.
Abstract
Objective
Ventriculoperitoneal shunt (VPS) placement is a common neurosurgical procedure, but the impact of general surgery (GS) participation during distal catheter insertion remains uncertain. The authors evaluated whether same-day abdominal access procedures during VPS placement are associated with improved 90-day shunt-related outcomes.
Methods
The authors performed a retrospective cohort study using the TriNetX network. Patients with a first recorded VPS procedure were identified using ICD-10 Procedure Coding System codes and stratified by the presence or absence of concurrent abdominal access procedures on the index date. Propensity score matching was used to balance demographics, comorbidities, abdominal conditions, prior CSF diversion, and perioperative factors. Outcomes from 1 to 90 days included VPS reoperation (primary), conversion to alternative CSF diversion, mechanical shunt complications, and other complications, including mortality, infection, epilepsy or seizures, wound disruption, and venous thromboembolism or pulmonary embolism.
Results
After propensity score matching, 8955 patients were included in each cohort with balanced baseline characteristics. At 90 days, the GS involvement cohort had lower VPS reoperation rates (2.68% vs 4.56%, p < 0.0001) and fewer mechanical shunt complications (8.01% vs 10.85%, p < 0.0001) than the neurosurgery-only cohort. Conversion to alternative CSF diversion was also less frequent in the GS involvement cohort (0.85% vs 1.71%, p < 0.0001). Mortality (5.30% and 5.51%, respectively; p = 0.524), infection (5.25% and 4.85%, respectively; p = 0.185), epilepsy or seizures (14.92% and 15.21%, respectively; p = 0.664), and wound disruption (2.20% and 1.80%, respectively; p = 0.080) were similar between the GS involvement and neurosurgery-only cohorts.
Conclusions
In a multicenter cohort, VPS placement with concurrent abdominal GS procedures was associated with lower 90-day VPS reoperation, conversion to alternative CSF diversion, and mechanical shunt complications, without increases in mortality, infection, or other 90-day complications. These findings support consideration of a multidisciplinary approach to distal catheter placement when GS expertise is available.