Shunt Failure—The First 30 Days

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 123-129
Author(s):  
Ryan P Lee ◽  
Sonia Ajmera ◽  
Fridtjof Thomas ◽  
Pooja Dave ◽  
Jock C Lillard ◽  
...  
Keyword(s):  
Selection Procedure ◽  
Research Database ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Forward Selection ◽  
Multivariable Logistic Regression Model ◽  
Shunt System ◽  
Index Model ◽  
Surgery Research ◽  
Significant Covariates

Abstract BACKGROUND Incontrovertible predictors of shunt malfunction remain elusive. OBJECTIVE To determine predictors of shunt failure within 30 d of index surgery. METHODS This was a single-center retrospective cohort study from January 2010 through November 2016. Using a ventricular shunt surgery research database, clinical and procedural variables were procured. An “index surgery” was defined as implantation of a new shunt or revision or augmentation of an existing shunt system. The primary outcome was shunt failure of any kind within the first 30 days of index surgery. Bivariate models were created, followed by a final multivariable logistic regression model using a backward-forward selection procedure. RESULTS Our dataset contained 655 unique patients with a total of 1206 operations. The median age for the cohort at the time of first shunt surgery was 4.6 yr (range, 0-28; first and third quartile, .37 and 11.8, respectively). The 30-day failure rates were 12.4% when analyzing the first-index operation only (81/655), and 15.7% when analyzing all-index operations (189/1206). Small or slit ventricles at the time of index surgery and prior ventricular shunt operations were found to be significant covariates in both the “first-index” (P < .01 and P = .05, respectively) and “all-index” (P = .02 and P < .01, respectively) multivariable models. Intraventricular hemorrhage at the time of index surgery was an additional predictor in the all-index model (P = .01). CONCLUSION This study demonstrates that only 3 variables are predictive of 30-day shunt failure when following established variable selection procedures, 2 of which are potentially under direct control of the surgeon.

scholarly journals Predicting shunt failure in children: should the global shunt revision rate be a quality measure?

2016 ◽  
Vol 17 (3) ◽  
pp. 249-259 ◽  
Author(s):  
Nicholas B. Rossi ◽  
Nickalus R. Khan ◽  
Tamekia L. Jones ◽  
Jacob Lepard ◽  
Joseph H. McAbee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Revision Rate ◽  
Shunt Revision ◽  
Failure Rates ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Shunt System ◽  
Pediatric Hydrocephalus ◽  
Model Selection Approach ◽  
Negative Findings

OBJECT Ventricular shunts for pediatric hydrocephalus continue to be plagued with high failure rates. Reported risk factors for shunt failure are inconsistent and controversial. The raw or global shunt revision rate has been the foundation of several proposed quality metrics. The authors undertook this study to determine risk factors for shunt revision within their own patient population. METHODS In this single-center retrospective cohort study, a database was created of all ventricular shunt operations performed at the authors’ institution from January 1, 2010, through December 2013. For each index shunt surgery, demographic, clinical, and procedural variables were assembled. An “index surgery” was defined as implantation of a new shunt or the revision or augmentation of an existing shunt system. Bivariate analyses were first performed to evaluate individual effects of each independent variable on shunt failure at 90 days and at 180 days. A final multivariate model was chosen for each outcome by using a backward model selection approach. RESULTS There were 466 patients in the study accounting for 739 unique (“index”) operations, for an average of 1.59 procedures per patient. The median age for the cohort at the time of the first shunt surgery was 5 years (range 0–35.7 years), with 53.9% males. The 90- and 180-day shunt failure rates were 24.1% and 29.9%, respectively. The authors found no variable—demographic, clinical, or procedural—that predicted shunt failure within 90 or 180 days. CONCLUSIONS In this study, none of the risk factors that were examined were statistically significant in determining shunt failure within 90 or 180 days. Given the negative findings and the fact that all other risk factors for shunt failure that have been proposed in the literature thus far are beyond the control of the surgeon (i.e., nonmodifiable), the use of an institution’s or individual’s global shunt revision rate remains questionable and needs further evaluation before being accepted as a quality metric.

Radiographic assessment of snap-shunt failure

2010 ◽  
Vol 6 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Anand I. Rughani ◽  
Bruce I. Tranmer ◽  
Jeffrey E. Florman ◽  
James T. Wilson
Keyword(s):  
Normal Values ◽  
Clinical Symptoms ◽  
Type System ◽  
Shunt Malfunction ◽  
Ct Scans ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Ct Finding

Accurate assessment of imaging studies in patients with ventriculoperitoneal shunts can be aided by empirical findings. The authors characterize an objective measurement easily performed on head CT scans with the goal of producing clear evidence of shunt fracture or disconnection in patients with a snap shunt–type system. The authors describe 2 cases of ventriculoperitoneal shunt failure involving a fracture and a disconnection associated with a snap-shunt assembly. In both cases the initial clinical symptoms were not convincing for shunt malfunction, and the interpretation of the CT finding failed to immediately identify the abnormality. As the clinical picture became more convincing for shunt malfunction, each patient subsequently underwent successful shunt revision. The authors reviewed the CT scans of 10 patients with an intact and functioning snap-shunt system to characterize the normal appearance of the snap-shunt connection. On CT scans the distance between the radiopaque portion of the ventricular catheter and the radiopaque portion of the reservoir dome measures an average of 4.72 mm (range 4.6–4.9 mm, 95% CI 4.63–4.81 mm). In the authors' patient with a fractured ventricular catheter, this interval measured 7.8 mm, and in the patient with a disconnection it measured 7.7 mm. In comparison with the range of normal values, a radiolucent interval significantly greater than 4.9 mm should promptly raise concern for a disconnected or fractured shunt in this system. This measurement may prove particularly useful when serial imaging is not readily available.

Evaluating the Statistical Significance of Models Developed by Stepwise Regression

1983 ◽  
Vol 20 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Shelby H. McIntyre ◽  
David B. Montgomery ◽  
V. Srinivasan ◽  
Barton A. Weitz
Keyword(s):  
Monte Carlo ◽  
Null Hypothesis ◽  
Regression Models ◽  
Stepwise Regression ◽  
Statistical Significance ◽  
Selection Procedure ◽  
Coefficient Of Determination ◽  
Forward Selection ◽  
Monte Carlo Simulation Study ◽  
Independent Variables

Information for evaluating the statistical significance of stepwise regression models developed with a forward selection procedure is presented. Cumulative distributions of the adjusted coefficient of determination ([Formula: see text]) under the null hypothesis of no relationship between the dependent variable and m potential independent variables are derived from a Monté Carlo simulation study. The study design included sample sizes of 25, 50, and 100, available independent variables of 10, 20, and 40, and three criteria for including variables in the regression model. The results reveal that the biases involved in testing statistical significance by two well-known rules are very large, thus demonstrating the desirability of using the Monté Carlo cumulative [Formula: see text] distributions developed by the authors. Although the results were derived under the assumption of uncorrelated predictors, the authors show that the results continue to be useful for the correlated predictor case.

The use of conditional cutoffs in a forward selection procedure

1987 ◽  
Vol 16 (8) ◽  
pp. 2227-2241 ◽  
Author(s):  
Sh I. Pinsker ◽  
Victor Kipnis ◽  
Eugen Grechanovsky
Keyword(s):  
Selection Procedure ◽  
Forward Selection

Ventriculoperitoneal Shunt Surgery Outcome in Adult Transition Patients With Pediatric-Onset Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 380-389 ◽  
Author(s):  
G. Kesava Reddy ◽  
Papireddy Bollam ◽  
Gloria Caldito ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Shunt Placement ◽  
Adult Transition ◽  
Shunt Survival ◽  
Pediatric Onset

Abstract BACKGROUND: Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus, albeit with many complications. OBJECTIVE: To review and assess the long-term clinical outcome of ventriculoperitoneal shunt surgery in adult transition patients with pediatric-onset hydrocephalus. METHODS: Patients 17 years or older who underwent ventriculoperitoneal shunt placement for hydrocephalus during their pediatric years (younger than 17 years) were included. Medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively. RESULTS: A total of 105 adult patients with pediatric-onset hydrocephalus were included. The median age of the patients was 25.9 years. The median age at the time of the initial ventriculoperitoneal shunt placement was 1.0 year. The median follow-up time for all patients was 17.7 years. The incidence of shunt failure at 6 months was 15.2%, and the overall incidence of shunt failure was 82.9%. Single shunt revision occurred in 26.7% of the patients, and 56.2% had multiple shunt revisions. The cause of hydrocephalus was significantly associated with shunt survival for patients who had shunt failure before the age of 17 years. Being pediatric at first shunt revision, infection, proximal shunt complication, and other causes were independently associated with multiple shunt failures. CONCLUSION: The findings of this retrospective study show that the long-term ventriculoperitoneal shunt survival remains low in adult transition patients with pediatric-onset hydrocephalus.

Telemetric Intracranial Pressure Recording via a Shunt System Integrated Sensor: A Safety and Feasibility Study

2017 ◽  
Vol 78 (06) ◽  
pp. 572-575 ◽  
Author(s):  
Elvis Hermann ◽  
Hans Heissler ◽  
Joachim Krauss ◽  
Philipp Ertl
Keyword(s):  
Intracranial Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Sampling Rate ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Shunt System ◽  
Measuring Device ◽  
Handheld Device ◽  
Additional Surgery ◽  
Postural Changes

Background The dynamics of intracranial pressure (ICP) after shunt surgery in patients with normal pressure hydrocephalus (NPH) are poorly known. Temporarily implanted parenchymal pressure probes are reliable for accurate ICP monitoring; however, a disadvantage of this method is that the ICP probe has to be explanted after a period of time, requiring additional surgery. We present two patients with NPH with an integrated ICP measuring device in the shunt system that allows for long-term postoperative telemetric monitoring of ICP. Methods Two patients (one man, 66 years old, and one woman, 78 years old) with normal pressure hydrocephalus underwent shunt surgery using the Aesculap-Miethke Sensor Reservoir (Potsdam) as an ICP measuring device integrated in the shunt system. On the first postoperative day and during follow-up examination 3 months later, several measurements of ICP were performed using a handheld device to read the Sensor Reservoir data. Postural changes such as lying down, sitting, and standing with different head postures were assessed according to an experimental protocol in a randomized order during which the ICP was measured. Results There were clear ICP responses due to postural changes, in line with physiologically expected values. Because the highest sampling rate of the Aesculap-Miethke Sensor Reservoir is 1 Hz for continuous measurement of ICP, however, the collected data have to be considered an approximation for actual ICP dynamics. Conclusion The Aesculap-Miethke Sensor Reservoir is an easy-to-use tool to measure ICP changes reliably in patients with a shunt system. The sampling rate and handling of data acquisition may eventually be developed further.

scholarly journals Factors and Predictors of Length of stay in Offenders diagnosed with schizophrenia- A Machine-learning-based approach

2020 ◽  
Author(s):  
Johannes Kirchebner ◽  
Moritz Günther ◽  
Martina Sonnweber ◽  
Alice King ◽  
Steffen Lau
Keyword(s):  
Machine Learning ◽  
Length Of Stay ◽  
Learning Algorithms ◽  
Evaluation Criteria ◽  
Selection Procedure ◽  
Legal Aspects ◽  
Influential Factors ◽  
Machine Learning Algorithms ◽  
Forward Selection ◽  
Factors Affecting

Abstract Background: Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study attempts to investigate factors contributing to long-term hospitalization of schizophrenic offenders referred to a Swiss forensic institution, using machine learning algorithms that are better suited than conventional methods to detect nonlinear dependencies between variables. Methods: In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic offenders were reviewed using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential factors for length of stay were preselected. Machine learning algorithms then identified the most efficient model for predicting length-of-stay. Results: Two factors have been identified as being particularly influential for a prolonged forensic hospital stay, both of which are related to aspects of the index offense, namely (attempted) homicide and the extent of the victim's injury. The results are discussed in light of previous research on this topic. Conclusions: In this study, length of stay was determined by legal considerations, but not by factors that can be influenced therapeutically. Results emphasize that forensic risk assessments should be based on different evaluation criteria and not merely on legal aspects.

scholarly journals Factors associated with admission to intensive care units in COVID-19 patients in Lyon-France

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0243709
Author(s):  
Philippe Vanhems ◽  
Marie-Paule Gustin ◽  
Christelle Elias ◽  
Laetitia Henaff ◽  
Cédric Dananché ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Ward ◽  
Fisher Exact Test ◽  
Forward Selection ◽  
Multivariable Logistic Regression Model ◽  
Chi Square ◽  
Exact Test ◽  
Total Hospital Stay

Introduction A new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analysing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Patients and methods In this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients presenting from the community for their first admission were prospectively collected and analysed. Characteristics of patients hospitalized in medical ward to those admitted in ICU were compared using Mann-Whitney and Chi-square or Fisher exact test when appropriate. Univariate logistic regression was first used to identify variables on admission that were associated with the outcome i.e. admission to an ICU versus total hospital stay in a medical ward. Forward selection was then applied beginning with sex, age and temperature in the multivariable logistic regression model. Results Of the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of ICU hospitalization with temperature (OR, 1.56 [95% CI, 1.06–2.28] per degree Celsius increase), oxygen saturation <90% (OR, 12.45 [95% CI, 5.27–29.4]), abnormal lung auscultation on admission (OR, 3.58 [95% CI, 1.58–8.11]), elevated level of CRP (OR, 2.7 [95% CI, 1.29–5.66for CRP>100mg/L vs CRP<10mg/L). and monocytopenia (OR, 3.28 [95% CI, 1.4–7.68]) were also associated with increasing odds of ICU hospitalization. Older patients were less likely to be hospitalized in ICU (OR, 0.17 [95%CI, 0.05–0.51]. Conclusions Age and delay between onset of symptoms and hospital admission were associated with the risk of hospitalisation in ICU. Age being a fixed variable, interventions that shorten this delay would improve the prognosis of Covid-19 patients.

Prognosis of hepatocellular carcinoma (HCC): Comparison of four staging systems in two French clinical trials

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4589-4589 ◽  
Author(s):  
S. Collette ◽  
F. Bonnetain ◽  
X. Paoletti ◽  
M. Doffoel ◽  
O. Bouche ◽  
...  
Keyword(s):  
Predictive Accuracy ◽  
Cox Model ◽  
External Validation ◽  
Selection Procedure ◽  
Alcoholic Cirrhosis ◽  
Information Criteria ◽  
Carcinome Hépatocellulaire ◽  
Forward Selection ◽  
Prognostic Information ◽  
Staging Systems

4589 Background: The aims of our study were to compare performances of 4 staging systems and to explore how to improve prognostic classification among French patients with HCC whose main aetiology is alcoholic cirrhosis. Methods: We have pooled 2 RCTs in palliative condition from Federation Francophone de Cancerologie Digestive (FFCD): - FFCD 9403 comparing tamoxifen vs symptomatic treatment and - FFCD 9402 comparing chemoembolization + tamoxifen vs tamoxifen alone. They had respectively included 416 and 122 patients. Performance of Okuda, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer group (BCLC) and GRoupe d’Etude et de Traitement du Carcinome Hépatocellulaire scores have been compared using: Akaike information criteria (AIC), discriminatory ability (Harrell’s c and the Royston’s D statistics), monocity of gradients and predictive accuracy (Schemper statistics Vs). To explore how to improve classifications univariate and multivariate Cox model were performed. Variables with univariate p< 0.10 have been retained for multivariate analyses. A forward selection procedure has then been implemented. Bootstraps validation was performed to test the robustness of our results. Analyses were done for each trial and for the pooled database with trial stratification. Results: Median OS was 5,3 months (IC 95%: [4,6; 6,2]), 402 patients had (75%) an alcoholic cirrhosis aetiology . As shown in Table 1 , CLIP staging had the best properties, followed by Okuda and BCLC. Performances of all staging systems were rather disappointing. WHO staging for CLIP or alphafetoprotein for BCLC allowed a significant improvement of prognostic information. Conclusions: Our results suggest that CLIP staging seems to be most adapted to french patients, it could be better by associating WHO PS. An external validation of our result will be performed on another trial in palliative condition. [Table: see text] No significant financial relationships to disclose.

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