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Revision surgery following CSF shunt insertion: how often could it be avoided?

  • Original Article - CSF Circulation
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Abstract

Background

Cerebrospinal fluid (CSF) shunt revision surgery represents a huge social and economic burden. Few studies, however, have evaluated shunt revision surgeries in the context of their avoidability, and existing data are from paediatric populations. Using ratings from an expert panel, we classified avoidable and unavoidable shunt revisions in a mixed cohort of CSF-shunt patients.

Methods

In a retrospective review of a prospectively maintained, single-centre database, we identified all shunt systems implanted for the first time over a 10-year period (2007–2016) and all subsequent revision surgeries with a follow-up of at least 1 year. A panel of five expert shunt surgeons classified each revision surgery as avoidable or unavoidable. Rates of each were calculated and correlated with clinical data.

Results

Of 210 revision surgeries (314 patients, mean age, 49.9 years; mean follow-up, 4.2 years), the panel judged 114 as unavoidable (54.3%) and 96 (45.7%) as avoidable. Level of surgeon education correlated with these rates, but even in the most experienced hands, 12.5% of revisions were classified as avoidable. Avoidable revisions occurred significantly earlier than unavoidable interventions (mean; 112 and 448 days, respectively) after the index surgery.

Conclusion

Rates of avoidable shunt revision surgery are alarmingly high, even in experienced hands. Avoidable revisions occur significantly earlier, predominantly within the first 3 months after the index surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum Kassel, Moenchberg Str. 41-43, 34125, Kassel, Germany

    Stefanie Kaestner & Wolfgang Deinsberger

  2. Kassel School of Medicine, University of Southampton, Southampton, UK

    Stefanie Kaestner & Wolfgang Deinsberger

  3. Applied statistics, Department 05, University of Kassel, Kassel, Germany

    Manuela Poetschke

  4. Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany

    Uwe Kehler

  5. Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany

    Sebastian Antes

  6. Department of Neurosurgery, University Clinic of Leipzig, Leipzig, Germany

    Matthias Krause

Authors
  1. Stefanie Kaestner
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  2. Manuela Poetschke
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  3. Uwe Kehler
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  4. Sebastian Antes
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  5. Matthias Krause
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  6. Wolfgang Deinsberger
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Correspondence to Stefanie Kaestner.

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This article is part of the Topical Collection on CSF Circulation

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Kaestner, S., Poetschke, M., Kehler, U. et al. Revision surgery following CSF shunt insertion: how often could it be avoided?. Acta Neurochir 162, 9–14 (2020). https://doi.org/10.1007/s00701-019-04083-0

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  • DOI: https://doi.org/10.1007/s00701-019-04083-0

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