Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases

2009 ◽  
Vol 4 (2) ◽  
pp. 166-169 ◽  
Author(s):  
N. u. Owase Jeelani ◽  
Abhaya V. Kulkarni ◽  
Pani DeSilva ◽  
Dominic N. P. Thompson ◽  
Richard D. Hayward
Keyword(s):  
Statistical Significance ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
Patient Age ◽  
Data Set ◽  
Street Hospital ◽  
Patient Âgé ◽  
Surgeon Experience ◽  
Shunt Infections

Object The purpose of this study was to audit some of the risk factors for CSF shunt infections within the authors' practice and analyze the statistical significance of these factors. Methods The authors used their own contemporaneously collected shunt database in this study. All shunt procedures performed over a 2-year period between March 2000 and February 2002 at Great Ormond Street Hospital, London, were analyzed. For the purposes of this study, positive CSF cultures were a prerequisite for a data set to qualify as a shunt infection. The authors studied the effects of patient age, the etiology of hydrocephalus, whether the surgery was primary shunt placement versus a revision, the surgeon's level of experience, whether the surgery was performed on an elective or emergency basis, and the presence or absence of a perioperative CSF leak. Statistical analyses were performed. Results Two hundred and five patients with a mean (± SD) age at surgery of 27.9 ± 43.0 months were included in this study. Shunt infections developed in 17 patients (8.3%) at a median of 42 days postoperatively (range 14–224 days). The presence of a perioperative CSF leak was the only variable that showed a statistically significant association with the occurrence of a shunt infection, with an infection rate of 57.1% compared to 4.7% in cases with no leak (OR 27.0 [95% CI 7.7–94.3]). The cause of hydrocephalus, elective versus emergency surgery, level of surgeon experience, a primary versus a revision procedure, and patient age did not have a bearing on the infection risk. Conclusions The presence of a perioperative CSF leak puts pediatric patients at a very high risk of shunt infection. Aside from prevention, the optimal management of such CSF leaks require further investigation.

Detailed standardized protocol to prevent cerebrospinal fluid shunt infection

2020 ◽  
Vol 132 (3) ◽  
pp. 755-759
Author(s):  
Yuma Okamura ◽  
Keisuke Maruyama ◽  
Shin Fukuda ◽  
Hiroshi Horikawa ◽  
Nobuyoshi Sasaki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Infection ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Patient Age ◽  
Protocol Implementation ◽  
Patient Âgé ◽  
Significant Difference ◽  
Before And After ◽  
Shunt Infections

OBJECTIVEWhile cerebrospinal fluid (CSF) shunt surgery plays an essential role in the treatment of hydrocephalus, postoperative infection due to the implantation of foreign materials is still one of the most common and potentially serious complications of this procedure. Because no previously reported protocol has been proven to prevent postoperative infection after CSF shunt surgeries in adults, the authors investigated the effectiveness of a protocol introduced in their institution.METHODSA detailed standardized surgical protocol to prevent infection in patients undergoing CSF shunt surgeries was introduced in the authors’ institution in December 2011. The protocol included a series of detailed rules regarding the surgical procedure, the surgical environment to minimize contamination from air, double gloving, local injection of antibiotics, and postoperative management. The rate of CSF shunt infection during the 3 years after surgery before and after implementation of the protocol was compared in patients undergoing their first CSF shunt surgeries. The inclusion periods were from January 2006 to November 2011 for the preprotocol group and from December 2011 to December 2014 for the postprotocol group.RESULTSThe study included 124 preprotocol patients and 52 postprotocol patients. The mean patient age was 59 years in both groups, ranging from 40 days to 88 years. Comparison of patient background factors, including known risk factors for surgical site infections, showed no significant difference between the patient groups before and after implementation of the protocol. While 9 patients (7.3%) developed shunt infections before protocol implementation, no shunt infections (0%) were observed in patients who underwent surgery after protocol implementation. The difference was statistically significant (p = 0.047).CONCLUSIONSThe authors’ detailed protocol for CSF shunt surgeries was effective in preventing postoperative infection regardless of patient age.

Multidisciplinary approach to cerebrospinal fluid shunt infection with an appeal for attention to details in assessment and standardization in reporting

2011 ◽  
Vol 7 (5) ◽  
pp. 452-461 ◽  
Author(s):  
Ken R. Winston ◽  
Susan A. Dolan
Keyword(s):  
At Risk ◽  
Multidisciplinary Approach ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Accurate Identification ◽  
Meaningful Information ◽  
Valid Data ◽  
Csf Shunt Infection ◽  
Criteria For Diagnosis ◽  
Shunt Infections

Object The goal of this study was to evaluate the problems encountered in monitoring CSF shunt infection, including the collection, analysis, and reporting of data. The authors propose a system that would produce more accurate, and hence more meaningful, information on shunt infection than do the methodologies and customs now in common use. Methods The authors reviewed and analyzed 19 years of quarterly records of a committee that has addressed CSF shunt infection in an ongoing manner. Results There are strong incentives, political and otherwise, to identify low rates of CSF shunt infection. Details of the composition and operation of a multidisciplinary approach to CSF shunt infection are summarized. Many factors affect the occurrence of shunt infection and its accurate assessment and reporting. Easily accessible sources for the identification of cases of shunt infections and for the assessment of an at-risk population often contain discrepancies in significant numbers. Conclusions Multidisciplinary oversight of the entire matter of CSF shunt infection enhances the chances for collecting accurate data, identifying causes of infection, and developing effective preventative strategies. Valid data require a mechanism for finding all individuals within the at-risk pool; the accurate identification of patients who had shunt infections; standard, pragmatic, and robust criteria for diagnosis of shunt infection; and multidisciplinary oversight of the entire process.

Chondrocyte Viability After Intra-articular Calcaneal Fractures in Humans

2007 ◽  
Vol 28 (6) ◽  
pp. 665-668 ◽  
Author(s):  
Scott T. Ball ◽  
Kyle Jadin ◽  
R. Todd Allen ◽  
Alexandra K. Schwartz ◽  
Robert L. Sah ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Calcaneal Fractures ◽  
Patient Age ◽  
Chondrocyte Viability ◽  
Articular Fractures ◽  
Patient Âgé ◽  
Post Traumatic ◽  
The Impact ◽  
Traumatic Arthritis ◽  
Time From Injury

Background: Chondral damage from the impact of injury may contribute to the high incidence of post-traumatic arthritis after calcaneal fractures, but this has yet to be proven. We sought to study the effect of intra-articular calcaneal fractures on chondrocyte viability and to correlate these effects with injury severity, time from injury to surgery, and patient age and co-morbidities. Methods: Irreducible osteochondral fragments from 12 patients undergoing operative treatment for intra-articular calcaneal fractures were analyzed. Control cartilage was obtained from four tissue donors who died of unrelated causes. The cartilage was assessed for chondrocyte viability through the full thickness of tissue using a Live/Dead assay followed by laser scanning confocal microscopy. Patient demographics including injury classification and severity, time from injury to surgery, and patient age were recorded. Results: Chondrocyte viability from fracture patients averaged 72.8% ± 12.9% (range 53% to 95%), which was significantly lower than the 94.8% ± 1.5% viability observed in the control specimens ( p = 0.005). Chondrocyte viability declined with higher energy injuries ( p = 0.13), time from injury to surgery ( p = 0.07), and increasing patient age ( p = 0.07). However, none of these factors reached a level of statistical significance. Conclusions: A significant decline in chondrocyte viability occurs after intra-articular fractures of the calcaneus. This may contribute to the development of post-traumatic arthritis.

scholarly journals Initial Experience with Digital Patient Briefing in Computed Tomography

2018 ◽  
Vol 191 (06) ◽  
pp. 540-546
Author(s):  
Babak Alikhani ◽  
Bennet Hensen ◽  
Arne Grosser ◽  
Maria Inés Cartes Febrero ◽  
Markus von Bestenbostel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Statistical Significance ◽  
Age Groups ◽  
Patient Age ◽  
Open Questions ◽  
Patient Âgé ◽  
Significant Difference ◽  
Student’S T ◽  
The Individual ◽  
Time Required

Purpose To assess digital patient briefing as an alternative to conventional paper documentation. Materials and Methods 502 patients with a planned computed tomography (CT) examination were selected for digital patient briefing using the E-ConsentPro software from Thieme Compliance on an iPad by Apple (Cupertino, California, USA). For the analysis, three age groups were formed. The time required for the patient briefing, the number of open questions as well as the time needed for discussion with physicians were determined. Student’s t-test was performed to assess statistical significance. Results There was no significant difference between patient age and briefing time which was about 20 minutes on average. The number of open or unclear questions increased with patient age. While patients younger than 30 years of age had about 2 open questions, patients over 30 and 60 years had about 4 and 5 questions, respectively. The total time needed for discussion with physicians was less than 2 minutes on average. A significant difference in the time required for discussion with physicians could not be observed between the individual age groups. Conclusion Tablet-based digital briefing allows the storage of patient documents with reasonable time and effort. Furthermore, it minimizes the risk of data loss. Key Points  Citation Format

Morbidity of Ventricular Cerebrospinal Fluid Shunt Surgery in Adults: An 8-Year Study

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 985-995 ◽  
Author(s):  
Anne-Marie Korinek ◽  
Laurence Fulla-Oller ◽  
Anne-Laure Boch ◽  
Jean-Louis Golmard ◽  
Bassem Hadiji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Operating Time ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
High Morbidity ◽  
Neurosurgical Procedures ◽  
Shunt Surgery ◽  
Shunt Placement

Abstract BACKGROUND: Cerebrospinal fluid (CSF) shunt procedures have dramatically reduced the morbidity and mortality rates associated with hydrocephalus. However, despite improvements in materials, devices, and surgical techniques, shunt failure and complications remain common and may require multiple surgical procedures. OBJECTIVE: To evaluate CSF shunt complication incidence and factors that may be associated with increased shunt dysfunction and infection rates in adults. METHODS: From January 1999 to December 2006, we conducted a prospective surveillance program for all neurosurgical procedures including reoperations and infections. Patients undergoing CSF shunt placement were retrospectively identified among patients labeled in the database as having a shunt as a primary or secondary intervention. Revisions of shunts implanted in another hospital or before the study period were excluded, as well as lumbo- or cyst-peritoneal shunts. Shunt complications were classified as mechanical dysfunction or infection. Follow-up was at least 2 years. Potential risk factors were evaluated using log-rank tests and stepwise Cox regression models. RESULTS: During the 8-year surveillance period, a total of 14 275 patients underwent neurosurgical procedures, including 839 who underwent shunt placement. One hundred nineteen patients were excluded, leaving 720 study patients. Mechanical dysfunction occurred in 124 patients (17.2%) and shunt infection in 44 patients (6.1%). These 168 patients required 375 reoperations. Risk factors for mechanical dysfunction were atrial shunt, greater number of previous external ventriculostomies, and male sex; risk factors for shunt infection were previous CSF leak, previous revisions for dysfunction, surgical incision after 10 am, and longer operating time. CONCLUSION: Shunt surgery still carries a high morbidity rate, with a mean of 2.2 reoperations per patient in 23.3% of patients. Our risk-factor data suggest methods for decreasing shunt-related morbidity, including peritoneal routing whenever possible and special attention to preventing CSF leaks after craniotomy or external ventriculostomy.

scholarly journals Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States

2009 ◽  
Vol 4 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Tamara D. Simon ◽  
Matthew Hall ◽  
Jay Riva-Cambrin ◽  
J. Elaine Albert ◽  
Howard E. Jeffries ◽  
...  
Keyword(s):  
The United States ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Infection Rates ◽  
Study Objective ◽  
Shunt Placement ◽  
Pediatric Hospitals ◽  
Csf Shunt Infection ◽  
Shunt Infections

Object Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors. Methods This retrospective cohort study included children 0–18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined. Results The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5–12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8–12.8% per patient and 1.4–5.3% per procedure. Conclusions Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional factors may contribute to variation in CSF shunt infection rates between centers, but further study is needed. Benchmarking and future prospective multicenter studies of CSF shunt infection will need to incorporate these and other patient, hospital, and surgeon factors.

Quantifying Sources of Bias in National Healthcare Safety Network Laboratory-Identified Clostridium difficile Infection Rates

2014 ◽  
Vol 35 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Valerie B. Haley ◽  
A. Gregory DiRienzo ◽  
Emily C. Lutterloh ◽  
Rachel L. Stricof
Keyword(s):  
At Risk ◽  
New York ◽  
Clostridium Difficile ◽  
The State ◽  
Patient Age ◽  
Data Set ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Patient Âgé ◽  
Not At Risk

Objective.To assess the effect of multiple sources of bias on state- and hospital-specific National Healthcare Safety Network (NHSN) laboratory-identified Clostridium difficile infection (CDI) rates.Design.Sensitivity analysis.Setting.A total of 124 New York hospitals in 2010.Methods.New York NHSN CDI events from audited hospitals were matched to New York hospital discharge billing records to obtain additional information on patient age, length of stay, and previous hospital discharges. “Corrected” hospital-onset (HO) CDI rates were calculated after (1) correcting inaccurate case reporting found during audits, (2) incorporating knowledge of laboratory results from outside hospitals, (3) excluding days when patients were not at risk from the denominator of the rates, and (4) adjusting for patient age. Data sets were simulated with each of these sources of bias reintroduced individually and combined. The simulated rates were compared with the corrected rates. Performance (ie, better, worse, or average compared with the state average) was categorized, and misclassification compared with the corrected data set was measured.Results.Counting days patients were not at risk in the denominator reduced the state HO rate by 45% and resulted in 8% misclassification. Age adjustment and reporting errors also shifted rates (7% and 6% misclassification, respectively).Conclusions.Changing the NHSN protocol to require reporting of age-stratified patient-days and adjusting for patient-days at risk would improve comparability of rates across hospitals. Further research is needed to validate the risk-adjustment model before these data should be used as hospital performance measures.

Recurrent cerebrospinal fluid shunt infection and the efficacy of reusing infected ventricular entry sites

2013 ◽  
Vol 11 (6) ◽  
pp. 635-642 ◽  
Author(s):  
Ken R. Winston ◽  
Joseph T. Ho ◽  
Susan A. Dolan
Keyword(s):  
Clinical Characteristics ◽  
Recurrent Infection ◽  
Shunt Infection ◽  
External Ventricular Drainage ◽  
Csf Shunt ◽  
Recurrent Infections ◽  
Inclusion Criteria ◽  
New Type ◽  
Csf Shunt Infection ◽  
Shunt Infections

Object The objective of this investigation was to review the clinical characteristics of recurrent CSF shunt infections in a large pediatric neurosurgical practice and to assess the safety and efficacy of reusing original ventricular entry sites for external ventricular drainage during treatment of infections and for subsequent reinsertion of shunts. Methods Prospectively accrued clinical data on all patients treated at Children's Hospital Colorado for CSF shunt infections within a 10.5-year span were retrospectively investigated. Results One hundred twenty-one consecutive cases of CSF shunt infection met inclusion criteria. Recurrent shunt infection attributable to the management of these infections occurred in 14 cases (11.6%). Three recurrent infections were with their original organisms, 7 were organisms different from the original organisms, and 4 were indeterminate. Conclusions Half or more of recurrent shunt infections were with organisms different from the original organism, and hence were new-type infections introduced during the management of the original infections. Incomplete eradication of original pathogens accounted for 3 (21.4%) of the 14 recurrent infections. Reusing recently infected or contaminated ventricular entry sites, both for CSF drainage during treatment and for implantation of new shunts, was as safe, with regard to risk of recurrent infection, as switching to new entry sites. Prior evidence of shunt infection is not, alone, a sufficient reason to change to a previously well-functioning site, and reuse of contaminated ventricular entry sites avoids all risks associated with making new ventricular entries.

Factors contributing to the medical costs of cerebrospinal fluid shunt infection treatment in pediatric patients with standard shunt components compared with those in patients with antibiotic-impregnated components

2007 ◽  
Vol 22 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Li-Mei Lin ◽  
Graeme F. Woodworth ◽  
Matthew J. McGirt ◽  
Benjamin Carson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Medical Costs ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Shunt Insertion ◽  
Average Hospital ◽  
Infection Treatment ◽  
Shunt Infections

Object Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems. Methods The authors retrospectively reviewed data obtained in all pediatric patients who had undergone CSF shunt insertion at their institution over a 3-year period. All patients were followed up for 12 months after surgery. The independent association between AIS catheter use and subsequent shunt infection was assessed by performing a multivariate proportional hazards regression analysis. Factors contributing to the medical costs associated with shunt infection were evaluated. Results Two hundred eleven pediatric patients underwent 353 shunting procedures. Two hundred eight shunts (59%) were placed with nonimpregnated catheters and 145 shunts (41%) were placed with AIS catheters. Twenty-five patients (12%) with non-AIS catheters experienced shunt infection, whereas only two patients (1.4%) with AIS catheters had a shunt infection within the 6-month follow-up period (p < 0.01). Among infected patients, infected patients with standard shunt components had a longer average hospital stay, more inpatient complications related to infection treatment, and more multiple organism infections and multiple antibiotic regimens, compared with those with AIS components. Conclusions Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.

scholarly journals Assessment of spring cranioplasty biomechanics in sagittal craniosynostosis patients

2017 ◽  
Vol 20 (5) ◽  
pp. 400-409 ◽  
Author(s):  
Alessandro Borghi ◽  
Silvia Schievano ◽  
Naiara Rodriguez Florez ◽  
Roisin McNicholas ◽  
Will Rodgers ◽  
...  
Keyword(s):  
Spring Model ◽  
Patient Age ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Sagittal Craniosynostosis ◽  
Patient Âgé ◽  
Age At Surgery ◽  
Initial Force ◽  
Implantation Period

OBJECTIVEScaphocephaly secondary to sagittal craniosynostosis has been treated in recent years with spring-assisted cranioplasty, an innovative approach that leverages the use of metallic spring distractors to reshape the patient skull. In this study, a population of patients who had undergone spring cranioplasty for the correction of scaphocephaly at the Great Ormond Street Hospital for Children was retrospectively analyzed to systematically assess spring biomechanical performance and kinematics in relation to spring model, patient age, and outcomes over time.METHODSData from 60 patients (49 males, mean age at surgery 5.2 ± 0.9 months) who had received 2 springs for the treatment of isolated sagittal craniosynostosis were analyzed. The opening distance of the springs at the time of insertion and removal was retrieved from the surgical notes and, during the implantation period, from planar radiographs obtained at 1 day postoperatively and at the 3-week follow-up. The force exerted by the spring to the patient skull at each time point was derived after mechanical testing of each spring model—3 devices with the same geometry but different wire thicknesses. Changes in the cephalic index between preoperatively and the 3-week follow-up were recorded.RESULTSStiffer springs were implanted in older patients (p < 0.05) to achieve the same opening on-table as in younger patients, but this entailed significantly different—higher—forces exerted on the skull when combinations of stiffer springs were used (p < 0.001). After initial force differences between spring models, however, the devices all plateaued. Indeed, regardless of patient age or spring model, after 10 days from insertion, all the devices were open.CONCLUSIONSResults in this study provide biomechanical insights into spring-assisted cranioplasty and could help to improve spring design and follow-up strategy in the future.

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