Article
Cerebrospinal fluid shunt surgery under ongoing system infectious conditions does not result in more shunt infections
Implantation von Liquorshunts unter Infektbedinungen resultiert nicht in erhöhten postoperativen Shuntinfektionen
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Authors
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Philipp Krauss
- Universitätsklinikum Augsburg, Klinik für Neurochirurgie, Augsburg, Deutschland
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Leonard Koch
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Arthur Wagner
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Amir Kaywan Aftahy
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
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Chiara Negwer
- Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Cerebrospinal fluid (CSF) shunting is a standard procedure in neurosurgery to treat hydrocephalus due to various etiologies. Shunt infection is a frequent complication requiring pharmacologic treatment or even surgical shunt-revision. In order to prevent shunt infection, shunt implantation during ongoing infection (ventriculitis, urinary tract infection etc.) is regularly avoided, but quick surgery, not waiting for an infection to be fully treated, can be favorable in some cases. If these infectious conditions significantly affect the rate of shunt-infections or revisions is not yet clarified. Aim of this study was to investigate the rate of adverse events in patients that underwent shunt implantation under such infectious conditions.
Methods: We performed a retrospective chart review of patients undergoing CSF-shunt surgery in a single tertiary neurosurgical center. Patients were dichotomized according to their infection status. Infectious was defined as ongoing systemic infection under antimicrobial therapy but not finally treated at the moment of surgery. Shunt-infection and shunt-revisions within 90 days, age, gender, shunt-type, etiology of hydrocephalus, functional status and immunosuppression were analyzed.
Results: 685 (309 female) patients (1526 screened) were analyzed. 119 underwent surgery under infectious conditions having higher overall complication rates (p=.02) without resulting in more shunt-infections (n=15 vs. 54; p=.32) or shunt-revisions (n=10 vs. 33; p=.29). Shunt-infection and shunt-revision were attributed to younger age (53 vs. 61y; p<0.01 / 53 vs. 61y; p< 0.001) and poorer functional status at discharge (KPSS: 40 vs. 50%; p<0.01 / 40 vs. 50%; p< 0.01). Cranioplasty together with shunt-surgery was a risk factor for shunt-infection (p<.001) and revision (p<.01). Brain tumor, SAH and TBI patients had higher infection/revision rates, while immunosuppression, gender or shunt-type had not.
Conclusion: Shunt surgery under infectious conditions did neither result in higher rates of shunt-infections nor shunt-revisions until 90 days after surgery but are attributed to the underlying disease and overall functional status. Infectious conditions should be avoided, if possible, but our data show that implantation can be performed, if further reasons favor surgery without delay.
