Predictors of Ventriculo-Peritoneal Shunt Failure in Pediatric Hydrocephalus Patients: A 12-Year Retrospective Cohort Study

Introduction: Ventriculo-peritoneal shunts are routinely used in the treatment of children with hydrocephalus. Shunt failure is one of the most common complications of shunt surgery. More than 20% of shunted patients experience failure in the first year and require revision surgery or shunt removal. Hence, by identifying the patients in whom the probability of failure is high, appropriate measures can be considered.

Methods: The study was conducted retrospectively on all pediatric hydrocephalus patients from 2010 to 2022. Patients who underwent first-hand ventriculoperitoneal shunting were included in the study. The primary outcomes were proximal dysfunction, distal dysfunction, and shunt infection. Cox regression analysis was performed with a backward stepwise selection method to find independent factors related to the risk of shunt failure. Survival analysis was performed to calculate the survival rate of the shunt at different times.

Results: A total of 512 patients underwent primary shunt placement. The median follow-up was 23.25 months. During this period, a total of 154 patients (30.08%) had shunt failure, with 69 (13.48%) having proximal malfunctions, 54 (10.35%) having infection, and 15 (2.93%) experiencing distal malfunction. Shunt failures were related to age < 12 months (HR: 1.68, CI95% 1.07-2.63, P=0.02) and history of EVD (HR: 1.85, CI95% 1.18-2.90, P< 0.01). Age less than 1 month (HR: 3.63, CI95% 1.30-10.16, P=0.01) and history of concurrent endoscopy (HR: 2.50, CI95% 1.06-5.90, P=0.04) were associated with increased risk of infectious malfunction. Age less than 12 months (HR: 2.03, CI95% 1.05-3.93, P=0.03), history of EVD (HR: 2.40, CI95% 1.29-4.47, P< 0.01), and type of shunt brand B (HR: 0.51, CI95% 0.29-0.88, P=0.02) were related to proximal malfunctions. No variable was found to have a significant relationship with distal dysfunction.

Conclusion : With the investigation done and the factors identified in the present study, a practical algorithm can be designed for hydrocephalus patients, with the aim of minimizing the risk of shunt failure.