Stefanie Kaestner1,2, Manuela Poetschke3, Uwe Kehler4, Sebastian Antes5, Matthias Krause6, Wolfgang Deinsberger7,8. 1. Department of Neurosurgery, Klinikum Kassel, Moenchberg Str. 41-43, 34125, Kassel, Germany. Stefaniekaestner@aol.com. 2. Kassel School of Medicine, University of Southampton, Southampton, UK. Stefaniekaestner@aol.com. 3. Applied statistics, Department 05, University of Kassel, Kassel, Germany. 4. Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany. 5. Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany. 6. Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany. 7. Department of Neurosurgery, Klinikum Kassel, Moenchberg Str. 41-43, 34125, Kassel, Germany. 8. Kassel School of Medicine, University of Southampton, Southampton, UK.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.