Tamara D Simon1, Jeremiah Butler2, Kathryn B Whitlock3, Samuel R Browd4, Richard Holubkov2, John R W Kestle5, Abhaya V Kulkarni6, Marcie Langley5, David D Limbrick7, Nicole Mayer-Hamblett8, Mandeep Tamber9, John C Wellons10, William E Whitehead11, Jay Riva-Cambrin5. 1. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. Electronic address: Tamara.Simon@seattlechildrens.org. 2. Department of Pediatrics, University of Utah, Salt Lake City, UT. 3. Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. 4. Department of Neurosurgery, University of Washington/Seattle Children's Hospital, Seattle, WA. 5. Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT. 6. Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Canada. 7. Department of Neurosurgery, St Louis Children's Hospital, Washington University in Saint Louis, St Louis, MO. 8. Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA. 9. Division of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, PA. 10. Section of Pediatric Neurosurgery, Division of Neurosurgery, Children's Hospital of Alabama, University of Alabama-Birmingham, Birmingham, AL. 11. Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Abstract
OBJECTIVE: To quantify the extent to which cerebrospinal fluid (CSF) shunt revisions are associated with increased risk of CSF shunt infection, after adjusting for patient factors that may contribute to infection risk. STUDY DESIGN: We used the Hydrocephalus Clinical Research Network registry to assemble a large prospective 6-center cohort of 1036 children undergoing initial CSF shunt placement between April 2008 and January 2012. The primary outcome of interest was first CSF shunt infection. Data for initial CSF shunt placement and all subsequent CSF shunt revisions prior to first CSF shunt infection, where applicable, were obtained. The risk of first infection was estimated using a multivariable Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HRs) with 95% CI. RESULTS: Of the 102 children who developed first infection within 12 months of placement, 33 (32%) followed one or more CSF shunt revisions. Baseline factors independently associated with risk of first infection included: gastrostomy tube (HR 2.0, 95% CI, 1.1, 3.3), age 6-12 months (HR 0.3, 95% CI, 0.1, 0.8), and prior neurosurgery (HR 0.4, 95% CI, 0.2, 0.9). After controlling for baseline factors, infection risk was most significantly associated with the need for revision (1 revision vs none, HR 3.9, 95% CI, 2.2, 6.5; ≥2 revisions, HR 13.0, 95% CI, 6.5, 24.9). CONCLUSIONS: This study quantifies the elevated risk of infection associated with shunt revisions observed in clinical practice. To reduce risk of infection risk, further work should optimize revision procedures.
OBJECTIVE: To quantify the extent to which cerebrospinal fluid (CSF) shunt revisions are associated with increased risk of CSF shunt infection, after adjusting for patient factors that may contribute to infection risk. STUDY DESIGN: We used the Hydrocephalus Clinical Research Network registry to assemble a large prospective 6-center cohort of 1036 children undergoing initial CSF shunt placement between April 2008 and January 2012. The primary outcome of interest was first CSF shunt infection. Data for initial CSF shunt placement and all subsequent CSF shunt revisions prior to first CSF shunt infection, where applicable, were obtained. The risk of first infection was estimated using a multivariable Cox proportional hazard model accounting for patient characteristics and CSF shunt revisions, and is reported using hazard ratios (HRs) with 95% CI. RESULTS: Of the 102 children who developed first infection within 12 months of placement, 33 (32%) followed one or more CSF shunt revisions. Baseline factors independently associated with risk of first infection included: gastrostomy tube (HR 2.0, 95% CI, 1.1, 3.3), age 6-12 months (HR 0.3, 95% CI, 0.1, 0.8), and prior neurosurgery (HR 0.4, 95% CI, 0.2, 0.9). After controlling for baseline factors, infection risk was most significantly associated with the need for revision (1 revision vs none, HR 3.9, 95% CI, 2.2, 6.5; ≥2 revisions, HR 13.0, 95% CI, 6.5, 24.9). CONCLUSIONS: This study quantifies the elevated risk of infection associated with shunt revisions observed in clinical practice. To reduce risk of infection risk, further work should optimize revision procedures.
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