The Preventable Shunt Revision Rate: A Multicenter Evaluation. Issue 3 (6th July 2018)

• Record Type: Journal Article
• Authors: Dave, Pooja; Venable, Garrett T; Jones, Tamekia L; Khan, Nickalus R; Albert, Gregory W; Chern, Joshua J; Wheelus, Jennifer L; Governale, Lance S; Huntoon, Kristin M; Maher, Cormac O; Bruzek, Amy K; Mangano, Francesco T; Mehta, Vivek; Beaudoin, Wendy; Naftel, Robert P; Basem, Jade; Whitney, Anna; Shimony, Nir; Rodriguez, Luis F; Vaughn, Brandy N; Klimo, Paul
• Is Part Of: Neurosurgery. Volume 84:Issue 3(2019)
• Page Start: 788
• Page End: 798
• Publication Date: 2018-07-06
• Subjects: Shunt malfunction -- Preventable shunt revision rate -- Quality -- Metrics -- Multicenter; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy263
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE: To evaluate the PSRR across multiple centers and determine associated variables. METHODS: Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS: A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure ( P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.