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

Figures & data

Table 1. Distribution of socio-demographic characteristics among children with hydrocephalus managed with VP shunt insertion at selected hospitals, Addis Ababa, Ethiopia, 2020 (N = 337).

Variables	Categories	Outcome		Total (%)
		Death (%)	Censored (%)
Age of patients (month)	<6	42 (33.1)	85 (66. 9)	127 (37.7)
	6–12	20 (24.1)	63 (75.9)	83 (24.6)
	12–59	25 (32.9)	51 (67.1)	76 (22.6)
	59–168	12 (23.5)	39 (76.5)	51 (15.1)
Sex of patients	Male	51(25.9)	146 (74.1)	197 (58.5)
	Female	48 (34.3)	92 (65.7)	140 (41.5)
Weight of patients (kg)	<6	14 (22.95)	47 (77.05)	61 (18.1)
	6–12	52 (28.9)	128 (71.1)	180 (53.4)
	>12	33 (33.4)	63 (65.6)	96 (28.5)
Residence	Rural	40 (29.6)	95 (70.4)	135 (40)
	Urban	59 (29.2)	143 (70.8)	202 (60)

Table 2. Diseases related characteristics of children with hydrocephalus who were undergoing VP shunt at selected hospitals, Addis Ababa, Ethiopia, 2020 (N = 337).

Variables	Category		Outcome		Total (%)
			Died (%)	Censored (%)
Type of hydrocephalus	Communicative		33 (31.1)	73 (68.9)	106 (31.5)
	Obstructive		62 (27.3)	152 (71)	214 (63.5)
	NPH		4 (23.5)	13 (76.5)	17 (5)
Causes of hydrocephalus	Congenital (n = 210)	Unclassified	0	14 (100.0)	14 (4.1)
		Aqueduct stenosis	11 (47.8)	12 (52.2)	23 (6.8)
		Dandy-walker malformation	10 (27.8)	26 (72.2)	36 (10.6)
		Chiari malformation	5 (38.5)	8 (61.5)	13 (3.8)
		Spinal Bifida	20 (19.2)	84 (80.8)	104 (30.9)
		Arachnoid cyst	0	5 (100)	5 (1.4)
		Encephalocele	5 (31.2)	11 (68.8)	16 (4.7)
		Total	51 (22.9)	159 (77.1)	210 (62.3)
	Acquired (n = 112)	Post-meningitis	12 (30)	28 (70)	40 (11.9)
		Tumor	11 (44)	14 (56)	25 (7.4)
		Post-traumatic brain injury	13 (65)	7 (35)	20 (5.9)
		Hemorrhage	3 (23)	10 (77)	13 (3.9)
		Post-surgical	3 (75.0)	1 (25.0)	4 (1.2)
		Pseudo tumor cerebri	2 (20.0)	8 (80.0)	10 (2.9)
		Total	44 (39.3)	68 (60.7)	112 (33.2)
	Idiopathic (n = 15)		4 (26.7)	11 (73.3)	15 (4.5)

Table 3. Distribution of management-related factors among children diagnosed with hydrocephalus who had undergone VP shunt surgery at selected hospitals, Addis Ababa, Ethiopia, 2020 (N = 337).

Variables	Categories	Outcome		Total (%)
		Death (%)	Censored (%)
Type of procedure	Emergency	26 (53)	23 (47)	49 (14.5)
	Elective	73 (25.3)	215 (74.7)	288 (85.5)
Type of VP shunt	Initial insertion	86 (27.7)	224 (72.3)	310 (92)
	Revised shunt	13 (48.1)	14 (51.9)	27 (8)
The proximal catheter insertion site	Right	90 (28.8)	223 (71.3)	313 (92.9)
	Left	4 (30.8)	9 (69.2)	13 (3.9)
	Frontal	1 (25)	3 (75)	4 (1.2)
	Occipital	4 (57.1)	3 (42.9)	7 (2)
Past procedures other than VP shunt	Craniotomy	3 (37.5)	5 (62.5)	8 (2.37)
	MMC repair	3 (60.0)	2 (40.0)	5 (1.48)
	Cranioplasty	0	1 (100)	1 (0.29)
	ETV	3 (75.0)	1 (25.0)	4 (1.19)
	EVD	0	4 (100)	4 (1.19)
	Total	9 (40.9)	13 (59.1)	22 (6.52)
Additional procedures at presentation	Craniotomy	6 (66.7)	3 (33.3)	9 (2.7)
	MMC repair	27 (24.8)	82 (75.2)	109 (32.3)
	Total	33 (28)	85 (72)	118 (35)
The specialty of the surgeon	Pediatrics neurosurgeon	8 (27.6)	21 (72.4)	29 (8.6)
	Non-pediatrics neurosurgeon	91 (29.5)	217 (70.5)	308 (91.4)

Abbreviations: VP, ventriculoperitoneal; MMC, meningomyelocele; ETV, endoscopic third ventricles; EVD, extra ventricular drains.

Figure 1. Overall Kaplan-Meier survival estimate among children with hydrocephalus who underwent ventriculoperitoneal shunting operation at selected hospitals, Addis Ababa, Ethiopia, 2020 (N = 337).

Table 4. Bi-variable and multivariable analysis output for children with hydrocephalus who had undergone VP shunt insertion operation at selected hospitals, Addis Ababa, Ethiopia, 2020 (N = 337).

Covariates	Categories	p-value	Crude HR (95% CI)	p-value	Adjusted HR (95% CI)
Age of the child (month)	<6	0.152	2.939 (1.471–4.875)	0.417	1.55 (0.97–2.44)
	6–12	–	1	–	1
	12–59	0.241	1.45 (0.61–2.09)	0.696	1.21 (0.77–1.90)
	59–168	0.313	2.56 (1.22–17.38)	0.107	2.46 (0.82–7.37)
Residence	Rural	0.028	2.35 (1.50–3.69)	0.661	0.79 (0.59–1.07)
	Urban	–	1	–	1
Spinal Bifida	Yes	0.048	1.64 (1.00–2.68)	0.856	1.04 (0.64–1.70)
	No	–	1	–	1
Traumatic brain injury	Yes	<0.001	3.16 (1.75–5.63)	<0.001	7.4 (3.210–16.88)*
	No	–	1	–	1
Type of hydrocephalus	Communicative	0.242	1.90 (1.28–2.83)	0.017	1.99 (1.18–3.36)*
	Obstructive	0.464	1.46 (0.53–4.04)	0.312	1.70 (0.61–4.72)
	NPH	–	1	–	1
Type of surgery	Emergency	0.003	1.99 (1.27–3.14)	0.015	1.86 (1.17–3.13)*
	Elective	–	1	–	1
Type of VP shunt	Initial shunt	–	1	–	1
	Revised	<0.001	6.88 (5.21–7.43)	0.008	8.01 (6.12–13.43)*
Hospital stay	<7 days	–	1	–	1
	≥7 days	0.001	1.04 (1.01–1.09)	0.043	0.88 (0.47–1.66)
Duration of antibiotics	<7 days	–	1	–	1
	≥7 days	0.417	1.05 (1.01–1.93)	0.049	2.46 (1.82–7.38)*
Sunset eye	Yes	0.005	6.32 (7.04–8.11)	0.007	1.813 (1.17–1.91)*
	No	–	1	–	1
The rapid head size increase	Yes	<0.001	4.52 (2.98–6.82)	0.016	2.05 (1.14–3.37)*
	No	–	1	–	1
Seizure	Yes	0.241	4.36 (2.92–6.50)	0.082	2.013 (1.17–3.47)
	No	–	1	–	1
Revised shunt	Yes	0.019	3.83 (2.55–5.76)	<0.001	2.13 (1.13–3.98)*
	No	–	1	–	1
Types of pathogen	Gram-negative	0.162	1.77(1.224–2.568)	0.006	1.95 (1.60–12.64)*
	Gram-positive	0.736	1.07(.708–1.629)	0.208	0.69 (0.40–1.22)
	No gram	–	1	–	1
	Reaction

Abbreviations: HR, hazard ratio; CI, confidence interval; NPH, normal pressure hydrocephalus; VP, ventriculoperitoneal.

*Significant at 5% level of significance.

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]