Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia

Abstract

Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt.

Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results.

Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04–14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18–3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21–16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17–3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12–13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17–3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14–3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82–7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60–12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.

Keywords:

• Hydrocephalus
• children
• survival status
• ventriculoperitoneal shunt
• Ethiopia

Acknowledgments

The authors would like to thank data collectors, supervisors, and respective hospitals involved in the study for their wholehearted contributions. We also want to appreciate Addis Ababa University that offered the chance and sponsored this study.

Disclosure statement

The authors declared no conflict of interest

Authors’ contributions

ABW, WEA & YBA participated in the study conception and design as well as collection and interpretation of data. GS & FA advised during proposal development, edited the proposal, and advised during data analysis. MSM, ABW & TMN participated in the design, performed the statistical analysis, as well as drafted and critically revised the manuscript. MSM edited the manuscript and formatted it for publication. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. However, St Peter Specialized Hospital provided the financial backing of this research. The funder had no role in study design, data collection, analysis, preparation of the manuscript, and decision on publication.

Data availability statement

Extra data that support the findings of this study are available from the corresponding author upon reasonable request and can be shared upon legal request via [email protected]

Consent for publication

Not applicable.