Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement

ABSTRACT

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.

KEYWORDS:

• Ventriculoperitoneal shunt
• gastrostomy
• shunt infection
• shunt revision
• cerebrospinal fluid

Acknowledgments

We would like to acknowledge Amanda M. Kwasnicki MD and Abhiraj D. Bhimani MD for their contributions toward data and literature review.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The code generated during the current study are available from the corresponding author on reasonable request.

Consent to participate

Informed consent was not required due to retrospective nature of study.

Consent for publication

Consent for publication not required due to lack of identifying information included in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

Study approval granted by UIC institutional review board.

Additional information

Funding

No funding was received for conducting this study.

Notes on contributors

Mandana Behbahani

Mandana Behbahani, M.D., Neurosurgery Resident, Department of Neurosurgery, University of Illinois at Chicago.

Clayton L. Rosinski

Clayton L. Rosinski, Medical Student Researcher, Department of Neurosurgery, University of Illinois at Chicago.

Nauman S. Chaudhry

Nauman S. Chaudhry, M.D., Neurosurgery Resident, Department of Neurosurgery, University of Illinois at Chicago.

Anisse N. Chaker

Anisse N. Chaker, Medical Student Researcher, Department of Neurosurgery, University of Illinois at Chicago.

Ryan G. Chiu

Ryan G. Chiu, Medical Student Researcher, Department of Neurosurgery, University of Illinois at Chicago.

Xinjian Du

Xinjian Du, M.D., M.P.H., Research Specialist, Department of Neurosurgery, University of Illinois at Chicago.

Ankit I. Mehta

Ankit I. Mehta, Assistant Professor, Department of Neurosurgery, University of Illinois at Chicago.

Gregory D. Arnone

Gregory D. Arnone M.D., Assistant Professor, Department of Neurosurgery, Penn State College of Medicine.

Sepideh Amin-Hanjani

Sepideh Amin-Hanjani M.D.: Professor of Neurosurgery and Co-Director of Neurovascular Surgery , Department of Neurosurgery, University of Illinois at Chicago.