scholarly journals Letter: Thirty-Day Hospital Readmission and Surgical Complication Rates for Shunting in Normal Pressure Hydrocephalus: A Large National Database Analysis

Neurosurgery ◽  
2020 ◽  
Author(s):  
Linda D’Antona ◽  
Simon David Thompson ◽  
Lewis Thorne ◽  
Laurence Dale Watkins ◽  
Ahmed Kassem Toma
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Hospital Readmission ◽  
Surgical Complication ◽  
Normal Pressure ◽  
National Database ◽  
Complication Rates ◽  
Day Hospital ◽  
Database Analysis ◽  
Large National Database

scholarly journals Thirty-Day Hospital Readmission and Surgical Complication Rates for Shunting in Normal Pressure Hydrocephalus: A Large National Database Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (6) ◽  
pp. 843-850 ◽  
Author(s):  
Jeffrey L Nadel ◽  
D Andrew Wilkinson ◽  
Joseph R Linzey ◽  
Cormac O Maher ◽  
Vikas Kotagal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Disease ◽  
Normal Pressure Hydrocephalus ◽  
Hospital Readmission ◽  
Surgical Complication ◽  
Normal Pressure ◽  
Healthcare Network ◽  
Severe Renal Disease ◽  
Perioperative Complication ◽  
Ventricular Shunting

Abstract BACKGROUND Research on age-related complications secondary to shunts in normal pressure hydrocephalus (NPH) is primarily limited to single-center studies and small cohorts. OBJECTIVE To determine the rates of hospital readmission and surgical complications, and factors that predict them, following shunt surgery for NPH in a large healthcare network. METHODS Surgical procedures, complications, and readmissions for adults undergoing ventricular shunting for NPH were determined using de-identified claims from a privately insured United States healthcare network in years 2007-2014. Univariate and multivariate statistics were used to determine factors that predict poor surgical outcomes. The primary outcome variable was surgical complications or readmissions (composite variable for any major perioperative complication or 30-d readmission). RESULTS The 30-d readmission rate for 974 patients with NPH who underwent ventricular shunting was 7.29%; the most common reasons for readmission were shunt-related complications, infection, hemorrhage, altered mental status, and cardiopulmonary and musculoskeletal problems. The perioperative complication rate was 21.15%, including intraparenchymal hemorrhage (5.85%) and extra-axial (subdural or epidural) hematoma (5.54%). The overall rate of having a surgical complication or 30-d readmission was 25.15%. Age did not predict surgical complication or 30-d readmission. Preoperative comorbidities independently associated with poor outcome were myocardial infarction within 1 yr (OR = 3.984, 95% CI = 1.105-14.368); existing cerebrovascular disease (odds ratio [OR] = 2.206, 95% CI = 1.544-3.152); and moderate/severe renal disease (OR = 2.000, 95% CI = 1.155-3.464). CONCLUSION The rate of complications or readmission within 30 d of ventricular shunting for NPH is 25.15%. Preoperative comorbidities of myocardial infarction within 1 yr, cerebrovascular disease, and moderate/severe renal disease are independent risk factors for poor outcome.

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

2021 ◽  
pp. 019459982110487
Author(s):  
Mohamed Abdelwahab ◽  
Sandro Marques ◽  
Isolde Previdelli ◽  
Robson Capasso
Keyword(s):  
Surgical Site Infection ◽  
Hospital Readmission ◽  
Antibiotic Prescription ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
National Database ◽  
Complication Rates ◽  
Site Infection ◽  
Tertiary Referral Center ◽  
Obstructive Sleep

Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

Overdrainage shunt complications in idiopathic normal-pressure hydrocephalus and lumbar puncture opening pressure

2013 ◽  
Vol 119 (6) ◽  
pp. 1498-1502 ◽  
Author(s):  
Qurat ul Ain Khan ◽  
Robert E. Wharen ◽  
Sanjeet S. Grewal ◽  
Colleen S. Thomas ◽  
H. Gordon Deen ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Normal Pressure Hydrocephalus ◽  
Subdural Hematoma ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Complication Rates ◽  
Shunt Surgery ◽  
Opening Pressure ◽  
Presenting Symptoms ◽  
Subdural Hematomas

Object Management of idiopathic normal-pressure hydrocephalus (iNPH) is hard because the diagnosis is difficult and shunt surgery has high complication rates. An important complication is overdrainage, which often can be treated with adjustable–shunt valve manipulations but also may result in the need for subdural hematoma evacuation. The authors evaluated shunt surgery overdrainage complications in iNPH and their relationship to lumbar puncture opening pressure (LPOP). Methods The authors reviewed the charts of 164 consecutive patients with iNPH who underwent shunt surgery at their institution from 2005 to 2011. They noted age, sex, presenting symptoms, symptom duration, hypertension, body mass index (BMI), imaging findings of atrophy, white matter changes, entrapped sulci, LPOP, valve opening pressure (VOP) setting, number of valve adjustments, serious overdrainage (subdural hematoma requiring surgery), radiological overdrainage (subdural hematomas or hygroma seen on postoperative imaging), clinical overdrainage (sustained or postural headache), other complications, and improvements in gait, urine control, and memory. Results Eight patients (5%) developed subdural hematomas requiring surgery. All had an LPOP of greater than 160 mm H2O and an LPOP-VOP of greater than 40 mm H2O. Radiological overdrainage was more common in those with an LPOP of greater than 160 mm H2O than in those with an LPOP of less than 160 mm H2O (38% vs 21%, respectively; p = 0.024). The BMI was also significantly higher in those with an LPOP of greater than 160 mm H2O (median 30.2 vs 27.0, respectively; p = 0.005). Conclusions Serious overdrainage that caused subdural hematomas and also required surgery after shunting was related to LPOP and LPOP-VOP, which in turn were related to BMI. If this can be replicated, individuals with a high LPOP should have their VOP set close to the LPOP, or even higher. In doing this, perhaps overdrainage complications can be reduced.

Lumbar drain trial outcomes of normal pressure hydrocephalus: a single-center experience of 254 patients

2020 ◽  
Vol 132 (1) ◽  
pp. 306-312 ◽  
Author(s):  
Tarek Y. El Ahmadieh ◽  
Eva M. Wu ◽  
Benjamin Kafka ◽  
James P. Caruso ◽  
Om J. Neeley ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Insertion Site ◽  
Normal Pressure ◽  
Csf Leak ◽  
Complication Rates ◽  
Lumbar Drain ◽  
Ventriculoperitoneal Shunting ◽  
History Of ◽  
Subarachnoid Spaces ◽  
The Mean

OBJECTIVEA short-term lumbar drain (LD) trial is commonly used to assess the response of normal pressure hydrocephalus (NPH) patients to CSF diversion. However, it remains unknown whether the predictors of passing an LD trial match the predictors of improvement after ventriculoperitoneal shunting. The aim of this study was to examine outcomes, complication rates, and associations between predictors and outcomes after an LD trial in patients with NPH.METHODSThe authors retrospectively reviewed the records of 254 patients with probable NPH who underwent an LD trial between March 2008 and September 2017. Multivariate regression models were constructed to examine predictors of passing the LD trial. Complications associated with the LD trial procedure were recorded.RESULTSThe mean patient age was 77 years and 56.7% were male. The mean durations of gait disturbance, cognitive decline, and urinary incontinence were 29 months, 32 months, and 28 months, respectively. Of the 254 patients, 30% and 16% reported objective and subjective improvement after the LD trial, respectively. Complications included a sheared LD catheter, meningitis, lumbar epidural abscess, CSF leak at insertion site, transient lower extremity numbness, slurred speech, refractory headaches, and hyponatremia. Multivariate analyses using MAX-R revealed that a prior history of stroke predicted worse outcomes, while disproportionate subarachnoid spaces (uneven enlargement of supratentorial spaces) predicted better outcomes after the LD trial (r2 = 0.12, p < 0.05).CONCLUSIONSThe LD trial is generally safe and well tolerated. The best predictors of passing the LD trial include a negative history of stroke and having disproportionate subarachnoid spaces.

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

2014 ◽  
Vol 120 (6) ◽  
pp. 1458-1464 ◽  
Author(s):  
Robert A. McGovern ◽  
Kathleen M. Kelly ◽  
Andrew K. Chan ◽  
Nicholas J. Morrissey ◽  
Guy M. McKhann
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Case Reports ◽  
Normal Pressure ◽  
Shunt Infection ◽  
Cardiovascular Complications ◽  
Complication Rates ◽  
Chi Square ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Programmable Valve ◽  
Cardiopulmonary Complications

Object Ventriculoatrial (VA) shunting is rarely used for patients with normal-pressure hydrocephalus (NPH), likely due to surgeon technical preference and case reports indicating cardiopulmonary complications. However, these complications have typically been limited to adults in whom VA shunts had been placed when they were children. Few studies have directly compared VA shunting to ventriculoperitoneal (VP) shunting in cases of NPH. Methods The authors retrospectively analyzed all NPH patients treated by a single surgeon at their center from January 2002 through December 2011. Thirty patients were treated with VA shunts (14 male) and 157 with VP shunts (86 male). The patients' mean age (± SD) at surgery was 73.7 ± 9.4 years for VA shunting and 76.0 ± 8.2 years for VP shunting; the median durations of follow-up were 42.0 months (IQR 19.2–63.6 months) and 34.2 months (IQR 15.8–67.5), respectively. Statistical analysis was performed using chi-square tests and Wilcoxon rank-sum tests. Results Perioperative and postoperative complications for VA and VP shunting cohorts, respectively, included distal revision (2.7% vs 6.6%, p = 0.45), proximal revision (2.7% vs 2.5%, p = 0.97), and postoperative seizure (2.7% vs 1.5%, p = 0.62). Shunt drainage–related subdural hematomas/hygromas developed in 8.1%/27.0% of VA shunt–treated patients versus 6.6%/26.4% of VP shunt–treated patients (p = 0.76/0.98) and were nearly always successfully managed with programmable-valve adjustment. Symptomatic intracerebral hemorrhage (1.5%) and shunt infection (2.0%) were only observed in those who underwent VP shunting. Of note, no cardiovascular complications were observed in any patient, and there were no cases of distal occlusion of the VA shunt. Conclusions The authors found no significant differences in complication rates between VA and VP shunting, and VA shunting was not associated with any cardiopulmonary complications. Thus, in the authors' experience, VA shunting is at least as safe as VP shunting for treating NPH.

scholarly journals Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort

2021 ◽  
Vol 12 ◽  
pp. 531
Author(s):  
Andrés Segura-Hernández ◽  
Fernando Hakim ◽  
Juan F. Ramón ◽  
Enrique Jiménez-Hakim ◽  
Juan A. Mejía-Cordovez ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Retrospective Cohort ◽  
Operating Time ◽  
Normal Pressure ◽  
The Elderly ◽  
Shunt Infection ◽  
Conventional Technique ◽  
Complication Rates ◽  
Perioperative Complication ◽  
Atrial Shunt

Background: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. Methods: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). Results: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. Conclusion: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.

scholarly journals Anti-TNF Use Prior to Bowel Resection Is Not Associated With 30 Day Postoperative Complications: A National Database Study

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Sean Pirkle ◽  
Sarah Bhattacharjee ◽  
Srikanth Reddy ◽  
Lewis L Shi ◽  
Michael J Lee ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Postoperative Complications ◽  
Tumor Necrosis ◽  
Bowel Resection ◽  
National Database ◽  
Control Group ◽  
Complication Rates ◽  
Database Analysis ◽  
Inflammatory Bowel ◽  
Necrosis Factor

Abstract Background Inflammatory bowel disease (IBD) patients are often counseled to pause anti-tumor necrosis factor (TNF) therapy before surgery. Here, we assessed the effects of preoperative anti-TNF treatment on bowel resection complications. Methods A national database analysis was performed. IBD patients who underwent bowel resection were included. Patients using preoperative anti-TNF were stratified by treatment regimen. Complication rates were compared between these groups and a control group with no anti-TNF history. Results Twenty thousand and sixty-eight patients matched our criteria. We observed no significant differences between preoperative anti-TNF regimens and postoperative bowel resection complications. Conclusions These data suggest that anti-TNF therapy may safely be continued prior to bowel resection.

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