TY - JOUR
T1 - Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement
AU - Behbahani, Mandana
AU - Rosinski, Clayton L.
AU - Chaudhry, Nauman S.
AU - Chaker, Anisse N.
AU - Chiu, Ryan G.
AU - Du, Xinjian
AU - Mehta, Ankit I.
AU - Arnone, Gregory D.
AU - Amin-Hanjani, Sepideh
N1 - Funding Information:
No funding was received for conducting this study. We would like to acknowledge Amanda M. Kwasnicki MD and Abhiraj D. Bhimani MD for their contributions toward data and literature review.
Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature. Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation. Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0–24 hr (immediate), 24 hr-7 days (early), and 7–30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods. Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration. Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS.
AB - Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature. Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation. Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0–24 hr (immediate), 24 hr-7 days (early), and 7–30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods. Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration. Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS.
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U2 - 10.1080/01616412.2021.1922174
DO - 10.1080/01616412.2021.1922174
M3 - Article
C2 - 33944706
AN - SCOPUS:85105382566
VL - 43
SP - 708
EP - 714
JO - Neurological Research
JF - Neurological Research
SN - 0161-6412
IS - 9
ER -