Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience

Objective: Infection remains the most significant complication of ventriculoperitoneal shunt surgery and the reported rates of cerebrospinal fluid shunt infection vary widely across studies in patients with hydrocephalus. The objective of this study is to review and evaluate the infections complicating ventriculoperitoneal shunt surgery in patients with hydrocephalus.

Methods: Patients who underwent ventriculoperitoneal shunt surgery for hydrocephalus between 1961 and 2010 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively.

Results: A total of 1015 patients with hydrocephalus who underwent ventriculoperitoneal shunt surgery were included. The mean and median follow-up was 9.2 and 6.5 years, respectively. The median age of the patients at the time of ventriculoperitoneal shunt placement was 41.6 years. Pediatric patients (<17 years) accounted for 30.0% of the patients. A total 1224 shunt revisions occurred in 1015 patients. Of the 1224 shunt revisions, 162 were due to infection, which occurred in a total of 107 patients. Single infection episodes occurred in 67 patients (6.6%), and multiple infection episodes occurred in 40 patients (3.9%). The overall infection rate was 7.2% per procedure and 10.5% per patient. The overall infection rate was 9.5% in pediatric patients and 5.1% in adult patients per procedure. Gender, age, and etiology of hydrocephalus were significantly associated with shunt infection. Pediatric patients had significantly lower infection-free survival than adults (79.9% vs. 94.4%, P<0.01).

Conclusions: Infection remains the most serious complication of ventriculoperitoneal shunt surgery. The findings of this retrospective study show that gender, age, and etiology of hydrocephalus significantly correlated independently with the incidence of infection. Prospective studies are needed to assess the observed associations between the risk factors and incidence of infection in hydrocephalus patients treated with ventriculoperitoneal shunt surgery.