Ventriculoperitoneal shunt complications in California: 1990 to 2000
Ventriculoperitoneal shunt complications in California: 1990 to 2000
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DOI：
10.1227/01.neu.0000290903.07943.af
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发表时间：
2007-09-01
期刊：
影响因子：
4.8
通讯作者：
Gupta, Nalin
中科院分区：
文献类型：
--
作者：
Wu, Yvonne;Green, Nella L.;Gupta, Nalin
背景技术背景：自现代手术技术出现以来，尚未使用人群、队列数据评估脑室腹腔（VP）分流术并发症的风险因素。我们对1990年至2000年所有非联邦加州医院住院患者进行了一项基于人群的回顾性队列研究，研究了人口统计学因素和VP分流并发症。方法：我们确定了全州行政医院出院数据库中所有表明VP分流插入的住院患者。在加州内重复住院，出院诊断为外科分流系统并发症，定义为分流系统置换、翻修、移除或探查，代表了关注的主要结局。我们进行了Kaplan-Meier生存分析和考克斯比例风险模型分析性别，年龄，种族，社会经济地位的基础上付款人的地位，脑积水的类型与分流并发症的风险。在14，455例患者中，随访65，040人-年，5年时的累积并发症发生率为32%。5年时，儿童的分流并发症发生率高于成人（48%对27%，P < 0.0001）。以下人口统计学因素与分流并发症风险增加独立相关：男性（风险比[HR]，1.1; 95%置信区间[CI]，1.03-1.2）、社会经济地位低（HR，1.2; 95% CI，1.1-1.3）和年龄小于19岁（HR，1.6; 95% CI，1.4-1.7）。与交通性脑积水相比，梗阻性脑积水也与分流术并发症的风险增加相关（HR，1.7; 95% CI，1.5-1.9）。结论：VP分流术并发症常见，尤其是在儿童中。需要进一步的研究来解释人口统计学因素与分流并发症发生率升高之间的关系。
BACKGROUND: Risk factors for ventricul operitoneal (VP) shunt complications have not been assessed with population, cohort data since the advent of modern surgical techniques. We examined demographic factors and VP shunt complications in a population-based retrospective cohort study of all nonfederal California hospital admissions between 1990 and 2000.METHODS: We identified all admissions in a statewide administrative hospital discharge database that indicated a VP shunt insertion. Repeat hospital admissions within California generating a discharge diagnosis of surgical shunt complication, defined as a shunt replacement, revision, removal, or exploration, represented the primary outcome of interest. We performed Kaplan-Meier survival analyses and Cox proportional hazards modeling to analyze sex, age, ethnicity, socioeconomic status based on payer status, and type of hydrocephalus in relation to the risk of shunt complications.RESULTS: The annual population incidence of VP shunt placement was 5.5 per 100,000. Among 14,455 individuals with 65,040 person-years of follow-up, the cumulative complication rate at 5 years was 32%. Children demonstrated a higher rate of shunt complications than did adults at 5 years (48 versus 27%, P < 0.0001). The following demographic factors were independently associated with increased risk of shunt complications: male sex (hazard ratio [HR], 1.1; 95% confidence interval [CI], 1.03-1.2), low socioeconomic status (HR, 1.2; 95% CI, 1.1-1.3), and age younger than 19 years (HR, 1.6; 95% Cl, 1.4-1.7). Compared with communicating hydrocephalus, obstructive hydrocephalus was also, associated,with increased risk of shunt complications (HR, 1.7; 95% Cl, 1.5-1.9).CONCLUSION: VP shunt complications are common, especially in children. Further study is needed to explain the associations between demographic factors and elevated shunt complication rate.