• Alexander E Merkler, Judy Ch'ang, Whitney E Parker, Santosh B Murthy, and Hooman Kamel.
• Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, New York, New York, USA; Department of Neurology, Weill Cornell Medicine, New York, New York, USA; Department of Neurology, Columbia University Medical Center, New York, New York, USA. Electronic address: alm9097@med.cornell.edu.
• World Neurosurg. 2017 Feb 1; 98: 654-658.

BackgroundAlthough ventriculoperitoneal shunt (VPS) surgery is the most frequent surgical treatment for patients with hydrocephalus, modern rates of complications in adults are uncertain.MethodsWe performed a retrospective cohort study of adult patients hospitalized at the time of their first recorded procedure code for VPS surgery between 2005 and 2012 at nonfederal acute care hospitals in California, Florida, and New York. We excluded patients who during the index hospitalization for VPS surgery had concomitant codes for VPS revision, central nervous system (CNS) infection, or died during the index hospitalization. Patients were followed for the primary outcome of a VPS complication, defined as the composite of CNS infection or VPS revision. Survival statistics were used to calculate the cumulative rate and incidence rate of VPS complications.ResultsA total of 17,035 patients underwent VPS surgery. During a mean follow-up of 3.9 (± 1.8) years, at least 1 VPS complication occurred in 23.8% (95% confidence interval [CI], 22.9%-24.7%) of patients. The cumulative rate of CNS infection was 6.1% (95% CI, 5.7%-6.5%) and of VPS revision 22.0% (95% CI, 21.1%-22.9%). Most complications occurred within the first year of hospitalization for VPS surgery. Complication rates were 21.3 (95% CI, 20.6-22.1) complications per 100 patients per year in the first year after VPS surgery, 5.7 (95% CI, 5.3-6.1) in the second year after VPS surgery, and 2.5 (95% CI, 2.1-3.0) in the fifth year after VPS surgery.ConclusionsComplications are not infrequent after VPS surgery; however, most complications appear to be clustered in the first year after VPS insertion.Copyright © 2016 Elsevier Inc. All rights reserved.

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