Abstract：
BACKGROUND: Shunt failure is an undesirable but common occurrence following neurosurgical shunting for pediatric hydrocephalus. Little is known about the occurrence of failure in lower-middle income country (LMIC) settings in South America. The objective of this study was to evaluate shunt failure in the sole publicly funded pediatric hospital in La Paz, Bolivia, with limited resources.
METHODS: A retrospective review of all patients at the Children\'s Hospital of La Paz, Bolivia (Hospital del Niño \"Dr. Ovidio Aliaga Uria\"), was conducted to identify all patients whose index surgical shunting for hydrocephalus was performed between 2019 and 2023. Categorical, continuous, and shunt failure data were statistically summarized.
RESULTS: A total of 147 unique pediatric patients underwent index ventriculoperitoneal shunting for hydrocephalus in the study period. There were 90 (61%) male and 57 (39%) female patients, with a median age of 2.2 months at index shunting procedure. The most common surgical indications were congenital hydrocephalus (n = 95, 65%), followed by hydrocephalus secondary to congenital defect (n = 25, 17%) and tumor (n = 18, 12%). A total of 18 (12%) of patients experienced inpatient failure during index admission requiring surgical revision at a median time of 12.5 days after index shunting. Postoperative imaging (OR 2.97, P = 0.037) and postoperative infection (OR 3.26, P = 0.032) during index admission both independently and statistically predicted inpatient failure. Of the 96 patients (65%) with postoperative follow-up, 16 (n = 16/96, 17%) patients experienced outpatient failure requiring readmission to hospital and surgical revision at a median time of 3.7 months after discharge. Kaplan-Meier estimations of overall inpatient and outpatient failure in this cohort were 23% (95% CI 14-37) and 28% (95% CI 15-49), respectively.
CONCLUSIONS: Both inpatient and outpatient shunt failures are significant complications in the management of pediatric hydrocephalus in La Paz, Bolivia. We identify multiple avenues to improve these outcomes which are institution-specific based on the review of these failures. Lessons learnt may be applicable to other similarly resourced institutions across South American LMICs.
METHODS: A retrospective review of all patients at the Children\'s Hospital of La Paz, Bolivia (Hospital del Niño \"Dr. Ovidio Aliaga Uria\"), was conducted to identify all patients whose index surgical shunting for hydrocephalus was performed between 2019 and 2023. Categorical, continuous, and shunt failure data were statistically summarized.
RESULTS: A total of 147 unique pediatric patients underwent index ventriculoperitoneal shunting for hydrocephalus in the study period. There were 90 (61%) male and 57 (39%) female patients, with a median age of 2.2 months at index shunting procedure. The most common surgical indications were congenital hydrocephalus (n = 95, 65%), followed by hydrocephalus secondary to congenital defect (n = 25, 17%) and tumor (n = 18, 12%). A total of 18 (12%) of patients experienced inpatient failure during index admission requiring surgical revision at a median time of 12.5 days after index shunting. Postoperative imaging (OR 2.97, P = 0.037) and postoperative infection (OR 3.26, P = 0.032) during index admission both independently and statistically predicted inpatient failure. Of the 96 patients (65%) with postoperative follow-up, 16 (n = 16/96, 17%) patients experienced outpatient failure requiring readmission to hospital and surgical revision at a median time of 3.7 months after discharge. Kaplan-Meier estimations of overall inpatient and outpatient failure in this cohort were 23% (95% CI 14-37) and 28% (95% CI 15-49), respectively.
CONCLUSIONS: Both inpatient and outpatient shunt failures are significant complications in the management of pediatric hydrocephalus in La Paz, Bolivia. We identify multiple avenues to improve these outcomes which are institution-specific based on the review of these failures. Lessons learnt may be applicable to other similarly resourced institutions across South American LMICs.
摘要：
背景：小儿脑积水神经外科分流术后分流失败是一种不受欢迎但常见的情况。人们对南美中低收入国家（LMIC）环境中失败的发生知之甚少。这项研究的目的是评估拉巴斯唯一一家公立儿科医院的分流失败，玻利维亚,有限的资源。
方法：对拉巴斯儿童医院的所有患者进行回顾性分析，玻利维亚医院（“OvidioAliagaUria博士”），对所有在2019年至2023年期间进行了脑积水手术分流的患者进行了鉴定。分类，连续,并对分流失败数据进行统计总结。
结果：在研究期间，共有147名独特的儿科患者因脑积水接受了脑室腹膜分流术。有90（61％）男性和57（39％）女性患者，指数分流手术的中位年龄为2.2个月。最常见的手术指征是先天性脑积水（n=95，65％），其次是继发于先天性缺损的脑积水（n=25，17％）和肿瘤（n=18，12％）。共有18例（12％）患者在索引入院期间经历了住院失败，需要在索引分流后12.5天的中位时间进行手术翻修。入院期间术后影像学（OR2.97，P=0.037）和术后感染（OR3.26，P=0.032）均独立且具有统计学意义地预测了住院失败。术后随访的96例患者（65%），16例（n=16/96，17％）患者在出院后的中位时间为3.7个月时发生门诊失败，需要再次入院和手术翻修。该队列中总体住院和门诊失败的Kaplan-Meier估计为23％（95％CI14-37）和28％（95％CI15-49），分别。
结论：住院和门诊分流失败都是拉巴斯小儿脑积水治疗中的重大并发症，玻利维亚。我们根据对这些失败的审查，确定了改善这些结果的多种途径，这些途径是针对特定机构的。吸取的经验教训可能适用于南美LMIC的其他类似资源的机构。
方法：对拉巴斯儿童医院的所有患者进行回顾性分析，玻利维亚医院（“OvidioAliagaUria博士”），对所有在2019年至2023年期间进行了脑积水手术分流的患者进行了鉴定。分类，连续,并对分流失败数据进行统计总结。
结果：在研究期间，共有147名独特的儿科患者因脑积水接受了脑室腹膜分流术。有90（61％）男性和57（39％）女性患者，指数分流手术的中位年龄为2.2个月。最常见的手术指征是先天性脑积水（n=95，65％），其次是继发于先天性缺损的脑积水（n=25，17％）和肿瘤（n=18，12％）。共有18例（12％）患者在索引入院期间经历了住院失败，需要在索引分流后12.5天的中位时间进行手术翻修。入院期间术后影像学（OR2.97，P=0.037）和术后感染（OR3.26，P=0.032）均独立且具有统计学意义地预测了住院失败。术后随访的96例患者（65%），16例（n=16/96，17％）患者在出院后的中位时间为3.7个月时发生门诊失败，需要再次入院和手术翻修。该队列中总体住院和门诊失败的Kaplan-Meier估计为23％（95％CI14-37）和28％（95％CI15-49），分别。
结论：住院和门诊分流失败都是拉巴斯小儿脑积水治疗中的重大并发症，玻利维亚。我们根据对这些失败的审查，确定了改善这些结果的多种途径，这些途径是针对特定机构的。吸取的经验教训可能适用于南美LMIC的其他类似资源的机构。
