Revision surgery following CSF shunt insertion: how often could it be avoided?
| Autor: | Stefanie Kaestner, Sebastian Antes, Uwe Kehler, Wolfgang Deinsberger, Manuela Poetschke, Matthias Krause |
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| Rok vydání: | 2019 |
| Předmět: |
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Reoperation medicine.medical_specialty Adolescent Ventriculoperitoneal Shunt 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Postoperative Complications Subsequent revision medicine Humans Child Neuroradiology Csf shunt medicine.diagnostic_test business.industry Interventional radiology Middle Aged medicine.disease Surgery Shunt (medical) Hydrocephalus Child Preschool Cohort Female Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery |
| Zdroj: | Acta neurochirurgica. 162(1) |
| ISSN: | 0942-0940 |
| Popis: | Cerebrospinal fluid (CSF) shunt revision surgery represents a huge social and economic burden. Few studies, however, have evaluated shunt revision surgeries in the context of their avoidability, and existing data are from paediatric populations. Using ratings from an expert panel, we classified avoidable and unavoidable shunt revisions in a mixed cohort of CSF-shunt patients. In a retrospective review of a prospectively maintained, single-centre database, we identified all shunt systems implanted for the first time over a 10-year period (2007–2016) and all subsequent revision surgeries with a follow-up of at least 1 year. A panel of five expert shunt surgeons classified each revision surgery as avoidable or unavoidable. Rates of each were calculated and correlated with clinical data. Of 210 revision surgeries (314 patients, mean age, 49.9 years; mean follow-up, 4.2 years), the panel judged 114 as unavoidable (54.3%) and 96 (45.7%) as avoidable. Level of surgeon education correlated with these rates, but even in the most experienced hands, 12.5% of revisions were classified as avoidable. Avoidable revisions occurred significantly earlier than unavoidable interventions (mean; 112 and 448 days, respectively) after the index surgery. Rates of avoidable shunt revision surgery are alarmingly high, even in experienced hands. Avoidable revisions occur significantly earlier, predominantly within the first 3 months after the index surgery. |
| Databáze: | OpenAIRE |
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