Pooja Dave1, Garrett T Venable2, Tamekia L Jones3, Nickalus R Khan2, Gregory W Albert4,5, Joshua J Chern6, Jennifer L Wheelus6, Lance S Governale7, Kristin M Huntoon8, Cormac O Maher9, Amy K Bruzek9, Francesco T Mangano10, Vivek Mehta11, Wendy Beaudoin11, Robert P Naftel12, Jade Basem13, Anna Whitney13, Nir Shimony14,15, Luis F Rodriguez14,15, Brandy N Vaughn16, Paul Klimo2,16,17. 1. Rhodes College, Memphis, Tennessee. 2. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee. 3. Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee. 4. Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas. 5. Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas. 6. Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia. 7. Division of Pediatric Neurosurgery, University of Florida, Gainesville, Florida. 8. Department of Neurosurgery, Ohio State University, Columbus, Ohio. 9. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. 10. Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 11. Stollery Children's Hospital, Edmonton, Alberta, Canada. 12. Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee. 13. Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee. 14. Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida. 15. Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida. 16. Le Bonheur Children's Hospital, Memphis, Tennessee. 17. Semmes Murphey, Memphis, Tennessee.
Abstract
BACKGROUND: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE: To evaluate the PSRR across multiple centers and determine associated variables. METHODS: Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS: A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.
BACKGROUND: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE: To evaluate the PSRR across multiple centers and determine associated variables. METHODS: Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS: A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.