• Wajd N Al-Holou, Thomas J Wilson, Zarina S Ali, Ryan P Brennan, Kelly J Bridges, Tannaz Guivatchian, Ghaith Habboub, Ajit A Krishnaney, Giuseppe Lanzino, Kendall A Snyder, Tracy M Flanders, Khoi D Than, and Aditya S Pandey.
• 1Department of Neurosurgery, Wayne State University, Detroit, Michigan.
• J. Neurosurg. 2019 Oct 1; 131 (4): 106210671062-1067.

ObjectiveGastrostomy tube placement can temporarily seed the peritoneal cavity with bacteria and thus theoretically increases the risk of shunt infection when the two procedures are performed contemporaneously. The authors hypothesized that gastrostomy tube placement would not increase the risk of ventriculoperitoneal shunt infection. The object of this study was to test this hypothesis by utilizing a large patient cohort combined from multiple institutions.MethodsA retrospective study of all adult patients admitted to five institutions with a diagnosis of aneurysmal subarachnoid hemorrhage between January 2005 and January 2015 was performed. The primary outcome of interest was ventriculoperitoneal shunt infection. Variables, including gastrostomy tube placement, were tested for their association with this outcome. Standard statistical methods were utilized.ResultsThe overall cohort consisted of 432 patients, 47% of whom had undergone placement of a gastrostomy tube. The overall shunt infection rate was 9%. The only variable that predicted shunt infection was gastrostomy tube placement (p = 0.03, OR 2.09, 95% CI 1.07-4.08), which remained significant in the multivariate analysis (p = 0.04, OR 2.03, 95% CI 1.04-3.97). The greatest proportion of shunts that became infected had been placed more than 2 weeks (25%) and 1-2 weeks (18%) prior to gastrostomy tube placement, but the temporal relationship between shunt and gastrostomy was not a significant predictor of shunt infection.ConclusionsGastrostomy tube placement significantly increases the risk of ventriculoperitoneal shunt infection.

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