• Rado Malalatiana Ramasy Razafindratovo, Celina Borges Migliavaca, Sylvie Chevret, and Charles Champeaux-Depond.
• Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, Paris, France.
• Neurosurgery. 2023 May 1; 92 (5): 894904894-904.

BackgroundHydrocephalus is a common neurological condition that usually requires internal ventricular cerebrospinal fluid shunt (IVCSFS). The reported infection rate (IR) varies greatly from below 1% up to over 50%, but no meta-analysis to assess the overall IR has ever been performed.ObjectiveTo determine the IVCSFS overall IR in the adult population and search for associated factors.MethodsSix databases were searched from January 1990 to July 2022. Only original articles reporting on adult IVCSFS IR were included. Random-effects meta-analysis with generalized linear mixed model method and logit transformation was used to assess the overall IR.ResultsOf 1703 identified articles, 44 were selected, reporting on 57 259 patients who had IVCSFS implantation and 2546 infections. The pooled IR value and its 95% CI were 4.75%, 95% CI (3.8 to 5.92). Ninety-five percent prediction interval ranged from 1.19% to 17.1%. The patients who had IVCSFS after intracranial hemorrhage showed a higher IR (7.65%, 95% CI [5.82 to 10], P -value = .002). A meta-regression by year of publication found a decreasing IR (-0.031, 95% CI [-0.06 to 0.003], P -value = .032) over the past 32 years.ConclusionIVCSF is a procedure that every neurosurgeon should be well trained to perform. However, the complication rate remains high, with an estimated overall IR of 4.75%. The IR is especially elevated for hydrocephalic patients who require IVCSFS after intracranial hemorrhage. However, decades of surgical advances may have succeeded in reducing IR over the past 32 years.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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