‘Possible shunt malfunction’ pathway for paediatric hydrocephalus—a study of clinical outcomes and cost implications

Autor: Atul Tyagi, Louise Higgins, Paul Chumas, John Goodden, Liting Tong, Gnanamurthy Sivakumar
Rok vydání: 2020
Předmět:
Zdroj: Child's Nervous System. 37:499-509
ISSN: 1433-0350
0256-7040
DOI: 10.1007/s00381-020-04878-y
Popis: Shunt insertion for hydrocephalus is a common paediatric neurosurgery procedure. Shunt complications are frequent with an estimated 20–40% failure rate within the first year, and 4.5% per year subsequently. We have an open-door ‘possible shunt malfunction’ pathway for children treated with a shunt or endoscopic third ventriculostomy, providing direct ward access to ensure rapid assessment and timely management of children. To audit the ‘possible shunt malfunction’ pathway in terms of clinical outcomes (percentage-confirmed shunt dysfunction and number of re-attendances) and costs. Clinical data for patients attending the triage service were prospectively recorded over 7 months—including the number of attendances, previous shunt revisions, shunt type, investigations performed (CT, x-rays), and outcome. Costings (e.g. costs of physician, inpatient stay, investigations) were obtained from the hospital’s procurement department. In the study period, there were 81 attendances by 62 patients and only 16% of attendances resulted in surgical management (either shunt revision or ETV). Approximately 17% of patients re-attended at least once. The average cost per attendance in our pathway was £765.57 ($969.63; €858.73). The total expenditure for the pathway over 7 months was £62,011.03 ($78,540.07; €69,556.81), with inpatient stay making up the biggest percentage of cost (49.2%). Only 16% (13 attendances) of those attending through our pathway required neurosurgical intervention. Investigations for possible blocked shunt come at significant health, social, and financial cost. High rates of shunt failure, re-attendance, investigations, and inpatient stays incur a sizable financial burden to the healthcare system.
Databáze: OpenAIRE
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