Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement
| Autor: | Sepideh Amin-Hanjani, Anisse N. Chaker, Gregory D. Arnone, Clayton L. Rosinski, Nauman S. Chaudhry, Mandana Behbahani, Ryan G. Chiu, Xinjian Du, Ankit I. Mehta |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Reoperation 0301 basic medicine medicine.medical_specialty medicine.medical_treatment Ventriculoperitoneal Shunt 03 medical and health sciences Postoperative Complications 0302 clinical medicine Primary outcome medicine Clinical endpoint Humans Aged Retrospective Studies Gastrostomy business.industry General Medicine Middle Aged medicine.disease Surgery Hydrocephalus 030104 developmental biology Neurology Steroid use Cohort Etiology Female Neurology (clinical) business 030217 neurology & neurosurgery Shunt (electrical) |
| Zdroj: | Neurological Research. 43:708-714 |
| ISSN: | 1743-1328 0161-6412 |
| DOI: | 10.1080/01616412.2021.1922174 |
| Popis: | Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature.Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation.Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0-24 hr (immediate), 24 hr-7 days (early), and 7-30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods.Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration.Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS. |
| Databáze: | OpenAIRE |
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