gms | German Medical Science

Objective: CSF shunt revision surgery accounts for a tremendous social and economic burden and lowering shunt revision rates is desirable. The amount of avoidable shunt revisions is unknown. Only a few studies analyzed the preventability of shunt revisions exclusively in pediatric cohorts. This study aimed to analyze the potential of avoidable shunt revisions in a mixed cohort of CSF-shunt patients.

Methods: A retrospective review of a prospectively maintained database identified all newly inserted shunt systems in a ten year period from 2007 to 2016 in a single center. Clinical data and all subsequent revisions surgeries with a follow up of at least one year were documented. Every revision surgery was assigned to one of the following categories: preventable, partly preventable and unpreventable. The assignment was decided by a group of 5 experienced shunt surgeons throughout the country. The rate of avoidable revisions was calculated and correlated with clinical data.

Results: 314 patients with a mean age of 49.9 years received 210 revision surgeries with a mean follow up of 4.2 years. 89 revisions were judged as unpreventable (42.4%). 67 revisions were partly preventable (31.9%), whereas 54 revisions (25.7%) were classified as preventable. Assuming a possible reduction of 50% in the "partly preventable" group the rate of avoidable revisions increases to 41.4%. The level of education and the years of surgical experience are linked to the rate of preventability, but even in very experienced hands 13.8% of their revisions are avoidable. Preventable and partly preventable revisions occur significantly earlier than unpreventable surgeries (mean 80, 130 and 547 days resp.) after index surgery

Conclusion: At least one fifth up to two fifth of all subsequent shunt revision surgeries are avoidable even in experienced hands. Avoidable revisions occur significantly earlier predominately within the first three months after surgery.