Risk Factors for Malfunction of Ventriculoperitoneal Shunts Performed by Medical Residents in Children: An Exploratory Study

Abstract

Introduction Ventriculoperitoneal shunts (VPSs) are common neurosurgical procedures, and in educational centers, they are often performed by residents. However, shunts have high rates of malfunction due to obstruction and infection, especially in pediatric patients. Monitoring the outcomes of shunts performed by trainee neurosurgeons is important to incorporate optimal practices and avoid complications.

Methods In the present study, we analyzed the malfunction rates of VPSs performed in children by residents as well as the risk factors for shunt malfunction.

Results The study included 37 patients aged between 0 and 1.93 years old at the time of surgery. Congenital hydrocephalus was observed in 70.3% of the patients, while 29.7% showed acquired hydrocephalus. The malfunction rate was 54.1%, and the median time to dysfunction was 28 days. Infections occurred in 16.2% of the cases. Cerebrospinal fluid leukocyte number and glucose content sampled at the time of shunt insertion were significantly different between the groups (p = 0.013 and p = 0.007, respectively), but did not have a predictive value for shunt malfunction. In a multivariate analysis, the etiology of hydrocephalus (acquired) and the academic semester (1^st) in which the surgery was performed were independently associated with lower shunt survival (p = 0.009 and p = 0.026, respectively).

Conclusion Ventriculoperitoneal shunts performed in children by medical residents were at a higher risk of malfunction depending on the etiology of hydrocephalus and the academic semester in which the surgery was performed.

Resumo

Introdução As derivações ventrículo-peritoneais (DVPs) são procedimentos neurocirúrgicos comuns e, em centros educacionais, muitas vezes são realizados por residentes. No entanto, os shunts apresentam altas taxas de mau funcionamento devido a obstrução e infecção, especialmente em pacientes pediátricos. O monitoramento dos resultados das válvulas realizadas por neurocirurgiões em treinamento é importante para incorporar as práticas ideais e evitar complicações.

Métodos No presente estudo, analisamos as taxas de mau funcionamento de DVPs realizados em crianças por residentes, assim como os fatores de risco para mau funcionamento da válvula.

Resultados O estudo incluiu 37 pacientes com idades entre 0 e 1,93 anos na época da cirurgia. Hidrocefalia congênita foi observada em 70,3% dos pacientes, enquanto 29,7% apresentaram hidrocefalia adquirida. A taxa de disfunção foi de 54,1% e o tempo médio para disfunção foi de 28 dias. Infecções ocorreram em 16,2% dos casos. O número de leucócitos do líquido cefalorraquidiano e o conteúdo de glicose coletados no momento da inserção da válvula foram significativamente diferentes entre os grupos (p = 0,013 e p = 0,007, respectivamente), mas não tiveram um valor preditivo para o mau funcionamento da válvula. Em uma análise multivariada, a etiologia da hidrocefalia (adquirida) e o semestre letivo (1°) em que a cirurgia foi realizada foram independentemente associados a menor sobrevida do shunt (p = 0,009 e p = 0,026, respectivamente).

Conclusão: Derivações ventrículo-peritoneais realizadas em crianças por médicos residentes apresentaram maior risco de mau funcionamento dependendo da etiologia da hidrocefalia e do semestre letivo no qual a cirurgia foi realizada.

Keywords

ventriculoperitoneal shunts - hydrocephalus - shunt malfunction - medical resident - teaching hospital - ventriculostomy

Palavras-chave

derivação ventrículo-peritoneal - hidrocefalia - disfunção de derivação ventrículo-peritoneal - hospital de ensino - ventriculostomia

Ethical Statement

The present retrospective study was approved by our institutional review board (IRB No. 2.533.607/2018). The parents of the patients signed informed consent forms.

Data Availability Statement

All data generated or analyzed during the present study can be retrieved upon request to the corresponding author.

Publication History

Received: 27 October 2021

Accepted: 18 January 2022

Article published online:
23 September 2022

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