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Ventriculoperitoneal Shunt 30-Day Failure Rate: A Retrospective International Cohort Study

Al-Tamimi, Yahia Z. MD*; Sinha, Priyank MRCS Ed*; Chumas, Paul D. FRCS (SN)*; Crimmins, Darach FRCS (SN); Drake, James FRCSC§; Kestle, John. MD; and the British Pediatric Neurosurgery Group Audit Committee; Hayward, Richard FRCS (SN); Solanki, Guirish A. FRCS (SN)#; Thomson, Simon FRCS (SN)*; Thorne, John FRCS (SN)**

doi: 10.1227/NEU.0000000000000196
Research-Human-Clinical Studies

BACKGROUND: With the need for transparency of surgical results, 30-day outcome measures have become increasingly important. Ventriculoperitoneal (VP) shunt failure is a substantial burden to patients and health care systems.

OBJECTIVE: This study introduces the 30-day VP shunt failure rate as a possible barometer of surgical outcome and demonstrates its use in a national (United Kingdom [UK]) study and makes comparison with 2 published randomized, controlled trials (RCT).

METHODS: A cohort study of all (except 1) pediatric neurosurgical centers in the UK and Ireland. All new and revision VP shunt operations were recorded for 2008 and 2009. Both newly placed and revised VP shunts were subject to Kaplan-Meier analysis, and 30-day failure rate was obtained. Data from 2 RCTs investigating new VP shunt technology were analyzed, and the 30-day failure rate was extracted for comparative purposes.

RESULTS: The overall 30-day and 1-year failure rates for new shunts were 12.9% and 28.8%, respectively. The 30-day failure rate from 2 RCTs was comparable (14% and 16%, respectively). The failure rate of the subsequent revision of those new shunts was 20.7% at 30 days and 40.4% at 1 year. According to these data, shunt survival appears to be better if performed by a consultant pediatric neurosurgeon for revision surgery only.

CONCLUSION: VP shunt survival in the UK is comparable to the published multicenter data investigating shunt survival. The 30-day failure rate may represent a better barometer of surgical outcome and should be used as a separate outcome measure in the design of future trials.

ABBREVIATIONS: CI, confidence interval

RCT, randomized controlled trial

UK, United Kingdom

VP, ventriculoperitoneal shunt

*Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom;

Department of Neurosurgery, Children's University Hospital, Dublin, Ireland;

§Department of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada;

Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada;

Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom;

#Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom;

**Department of Neurosurgery, Royal Manchester Children's Hospital, Manchester, United Kingdom

Correspondence: Paul Chumas, FRCS (SN), Department of Neurosurgery, Level G Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, UK LS1 3EX. E-mail:

Received March 13, 2013

Accepted September 25, 2013

Copyright © by the Congress of Neurological Surgeons