Outcomes of VP Shunt Surgery for Hydrocephalus in Children in Low and Middle Income Countries: A Systematic Review

Introduction: Ventriculoperitoneal shunt (VPS) placement is essential for treating hydrocephalus, particularly in pediatric patients. While VPS is effective, complications like infection, disconnection, and obstruction are common. This review synthesizes findings from 590 studies on VPS complications and outcomes in pediatric populations across low- and middle-income countries (LMICs), addressing gaps in understanding compared to high-income countries (HICs). We aim to inform healthcare policy to enhance surgical outcomes and post-operative care in LMICs.

Methods: Following PRISMA guidelines and AMSTAR 2 quality assessment, we conducted a systematic review of English-language studies on pediatric VPS surgeries in LMICs, excluding adult (>18 years) and HIC data, across PubMed/Medline, Embase, Cochrane Library, Web of Science, Global Index Medicus, and Google Scholar. Data extracted included demographics, complications, and outcomes. Descriptive analyses were performed using Google Spreadsheets and R. This study is registered with PROSPERO (CRD42022383668).

Results: Of the 590 studies reviewed, data from 25,950 patients, primarily aged 0-5 years (86.9%), were analyzed. Complications included infections (predominantly Staphylococcus spp.), shunt failures, and obstructions. Outcomes were reported in 27.7% (7,184 patients): favorable outcomes in 68.1%, unfavorable outcomes in 13.1%, and an overall mortality rate of 18.8%.

Conclusion : This review highlights the substantial complications and mortality associated with VPS in LMICs, underscoring the urgent need for targeted interventions to improve pediatric outcomes. Infection remains a leading complication, primarily due to Staphylococcus spp., and points to a critical area for improvement in surgical and post-operative care practices. Future research should focus on longitudinal studies and developing cost-effective strategies to reduce VPS complications. Enhanced international collaborations are essential to building global neurosurgical capacity, ensuring pediatric patients in LMICs have access to high-quality care.