• Pooja Dave, Garrett T Venable, Tamekia L Jones, Nickalus R Khan, Gregory W Albert, Joshua J Chern, Jennifer L Wheelus, Lance S Governale, Kristin M Huntoon, Cormac O Maher, Amy K Bruzek, Francesco T Mangano, Vivek Mehta, Wendy Beaudoin, Robert P Naftel, Jade Basem, Anna Whitney, Nir Shimony, Luis F Rodriguez, Brandy N Vaughn, and Paul Klimo.
• Rhodes College, Memphis, Tennessee.
• Neurosurgery. 2019 Mar 1; 84 (3): 788-798.

BackgroundThe Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric.ObjectiveTo evaluate the PSRR across multiple centers and determine associated variables.MethodsNine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach.ResultsA total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center.ConclusionPSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.Copyright © 2018 by the Congress of Neurological Surgeons.

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