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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Requirement for and cost analysis of routine postoperative CT imaging following ventriculoperitoneal shunt surgery in adults. More harm than help?

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  • Bedjan Behmanesh - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Fee Keil - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Daniel Dubinski - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Sae-Yeon Won - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Johanna Quick-Weller - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Volker Seifert - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
  • Florian Geßler - Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV149

doi: 10.3205/18dgnc152, urn:nbn:de:0183-18dgnc1520

Published: June 18, 2018

© 2018 Behmanesh et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Patients with a ventriculoperitoneal shunt for hydrocephalus often undergo multiple follow-up computed tomography (CT) scans of the head, increasing the risk for long term effects of ionizing radiation. The purpose of our study was to evaluate the necessity and cost analysis of routine postoperative head CT scan after ventriculoperitoneal shunt surgery.

Methods: In this study, we studied adults with ventriculoperitoneal shunt operations, who underwent early CT scans within 48 hours postoperatively. We reviewed the correlation between revision surgery rate and the experience of surgeons, who performed surgery and provided a cost analysis. Furthermore, the bifrontal ventricular span as well as the Evans ratio, the surgical site of approach were analyzed to find predictive factors for revision surgery.

Results: 471 surgeries were performed in 432 patients. Early revision surgery was performed in 11 (2.3%) patients. Reason for revision surgery was malposition in 9 cases and intracerebral hemorrhage in 2 patients. There was no significant correlation between the surgeon’s experience and the rate of revision surgery. Placement of the ventricular catheter via an approach other than a standard right or left frontal burr hole resulted in increased risk of surgical shunt revision (p = < 0.005, odds ratio 50, 95%CI [11,11 - 200]). The cost analysis revealed a saving potential of almost 66000 € by omitting postoperative head CT scans. There were no statistical significant difference affecting sex, gender, surgical approach, bifrontal ventricular span and the Evans ratio.

Conclusion: Routine postoperative head CT scans after VP shunting is not necessary. The reduction of exposure to ionization radiation and the beneficial economic factor are main advantages.