A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children
A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children
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DOI：
10.1227/01.neu.0000316012.20797.04
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发表时间：
2008-02-01
期刊：
影响因子：
4.8
通讯作者：
Shah, Samir S.
中科院分区：
文献类型：
--
作者：
Berry, Jay G.;Hall, Matthew A.;Shah, Samir S.
目的：评价儿童脑脊室分流术后再通的危险因素和预测因素。方法：对儿科卫生信息系统数据库中32家独立的儿童医院2000年至2005年间1307名0~18岁首次脑室分流术后的儿童进行回顾性纵向队列研究。结果：37%的儿童在首次分流术后5年内需要至少一次分流；20%的儿童需要两次或两次以上的分流。在队列中的32家医院中，首次分流修复的机构比率从最初分流的20%到70%不等。每年进行1-20次初始分流的医院的初始分流改良率最高(42%)。每年进行83次分流手术的医院改良率最低(22%)。我们发现，在中西部接受分流术的儿童在控制了医院容量、分流类型、年龄和与初始分流相关的诊断后，更有可能经历多次分流修正(优势比为1.25；95%可信区间为1.06-1.47)。结论：初始分流术后医院容量较大的儿童的翻修率较低。不同儿童医院的脑室分流再造率有很大的差异。未来需要进行前瞻性研究，以研究不同医院间分流复通率差异的原因，包括具体护理过程的差异。
OBJECTIVE: To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children.METHODS: A retrospective, longitudinal cohort of 1307 children ages 0 to 18 years undergoing initial ventricular shunt placement in the year 2000, with follow-up through 2005, from 32 freestanding children's hospitals within the Pediatric Health information Systems database was studied. Rates of ventricular shunt revision were compared with patient demographic, clinical, and hospital characteristics with use of bivariate and multivariate regression accounting for hospital clustering.RESULTS: Thirty-seven percent of children required at least one shunt revision within 5 years of initial shunt placement; 20% of children required two or more revisions. Institutional rates of first shunt revision ranged from 20 to 70% of initial shunts placed among the 32 hospitals in the cohort. Hospitals where one to 20 initial shunt placements per year experienced the highest initial shunt revision rate (42%). Hospitals performing over 83 initial shunt placements per year experienced the lowest revision rate (22%). We found that children undergoing shunt placement in the Midwest were more likely to experience multiple shunt revisions (odds ratio, 1.25; 95% confidence interval, 1.06-1.47) after controlling for hospital volume, shunt type, age, and diagnosis associated with initial shunt placement.CONCLUSION: Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.